In this Section

The Education and Scholarship section offers not only tools and strategies, but provides more in-depth readings for preparation, pedagogical development, personal growth, and self-reflection. This section will support nurse educators as they address diversity, equity, and inclusion in teaching and learning environments.

Click on the links below to navigate throughout the section.

Strategies

Tools

Institutional Viability & Capacity

Access & Success

Climate & intergroup relations

Education & Scholarship

Education and Scholarship

Education and Scholarship focuses on the academic core and the scholarly focus of a school of nursing. As a discipline, the center of nursing's focus is the whole person (body, mind, and spirit) with the influence of the environment on an individual's health and recovery being of utmost importance. Moreover, as an academic discipline nursing recognizes that students must not only be introduced to the knowledge and values of the discipline, but they must also appreciate how the social, political, and economic environment influences health.

 Building Faculty Capacity

Assessing the Landscape

In his book Diversity Explosion, William Frey (2018) used data from the U.S. Census Bureau to examine population projections through 2050. The data supported the expansion of minority groups over the next 30 years where each group will more than double. Racially and ethnically diverse individuals contributed more than three quarters of the nation’s population growth in the past decade, and this trend will accelerate in the future. By 2050, the federal government projects that racially and ethnically diverse persons will comprise 53 percent of the United States population (U.S. Census Bureau, 2019). This indicates that the future population of students entering schools of nursing will come from more diverse backgrounds. However, when we examine the outcomes of higher education graduation rates, we see gaps in race and ethnicity among those who graduate and those who do not.

According to the National Center for Education Statistics, the 6-year graduation rate for first-time, full-time undergraduate students who began their pursuit of a baccalaureate degree at a 4-year degree-granting institution in fall 2010 was highest for Asian students (74 percent), followed by White students (64 percent), students of two or more races (60 percent), Hispanic students (54 percent), Pacific Islander students (51 percent), Black students (40 percent), and American Indian/Alaska Native students (39 percent).

breakdown of graduation 4, 5, and 6 year graduation rates

Table 326.20 (Digest of Education Statistics 2017) Graduation rate from first institution attended within 150 percent of normal time for first-time, full-time degree/certificate-seeking students at 2-year postsecondary institutions, by race/ethnicity, sex, and control of institution: Selected cohort entry years, 2000 through 2013

Diversity, like technology, represents a powerful change in our environment. Similar to technology, we must actively engage in the area of DEI to be successful in a society that is ever more pluralistic and diverse. Diversity offers strategic opportunities to fulfill an organization’s mission and advance institutional excellence. However, diversity offers some challenges. Faculty development has been a central part of diversity work, and faculty must be involved in the curriculum transformation that is required. These efforts have been more successful when the approach is linked to the academic mission and values of the institution. Efforts are less successful where curriculum change seems to be superficial effort to transform the appearance of the syllabus rather than engage the substantive perspectives that diversity raises for scholarship and pedagogy. By embracing a diversity framework, institutions can move toward inclusive excellence.

A Justice Imperative

“The demographic and economic imperatives for racial equity are oriented toward the future: the projected racial-ethnic makeup of the American population and the economic prospects of the country. Racial inequity, however, is a problem that was born in the past and that has endured over time. It was born out of slavery and subsequent Jim Crow laws that legalized segregation and limited opportunity for Blacks. It was born out of genocide and land-grabbing that diminished the population and territories of Native Americans, as well as out of the colonization and assimilation projects that sought to “civilize” the “savage natives.” It was born out of waves of Asian, Latinx, and Pacific Islander migration, some of which was sanctioned by the American government (e.g., through the Immigration Act of 1965 and asylum seeking) and some of which was not. For all people of color, racial inequity was born from policies and practices that were designed to benefit the dominant population of whites and to directly and/or indirectly exclude, marginalize, and oppress people of color. Addressing racial inequity is therefore an act of justice that requires explicit attention to structural inequality and institutionalized racism, and demands system-changing responses.”
Source
: Center for Urban Education. (2020). Laying the groundwork: Concepts and activities for racial equity work. Rossier School of Education, University of Southern California.

Previous research provide evidence about what college students want from their professors: accessibility (Case, 2013), warmth (Morrow & Ackerman, 2012), organizational detail (Weaver & Qi, 2005), and compassion (O’Keeffe, 2013) are among the characteristics reported in the literature. Students want to know that they can reach out to faculty when they need support or encouragement (Booker, 2016). Students also expect faculty to be sensitive to their feelings and maintain a respectful environment that is not hindered by disrespect and antagonism. Booker (2018) concluded in her study How faculty create learning environments for diversity and inclusion, that faculty who want to develop an inclusive environment are tasked with supporting student connections with their teacher, their peers, and the course content.

References

View references [PDF]

 Create Inclusive Teaching and Learning Environments

Creating inclusive teaching and learning environments involves developing critical skills that include managing microaggressions, conflicts, charged conversations, and discrimination in respectful, psychologically safe ways. Josiah Macy Jr. Foundation. (2020). Addressing harmful bias and eliminating discrimination in health professions learning environments.

Mindful and Learner-Centered Checklist

 Inclusive Pedagogies

Principles of Inclusive Pedagogy

  • Flexibility: Be open to change
  • Equity: Creating opportunities for equal access and success for students who have historically underrepresented
  • Collaboration between students and other stakeholders to enrich the experience
  • Personalization and individualization that recognizes and honors differences
  • Diversity
  • Develop an awareness of diversity and global issues

https://www.celt.iastate.edu/teaching/creating-an-inclusive-classroom/inclusive-teaching-resources/inclusive-pedagogy/

Effective Practices in Inclusive Pedagogy

  • Nurse educators may not be aware of how their biases regarding cultural diversity affect their actions toward students and patients. Implicit bias among healthcare providers can affect patient outcomes and clinical judgement (Sukhera & Watling, 2018). Marion et al. (2017) suggested that nursing faculty use the Implicit Assessment Test (IAT) (Gatewood, Broholm, Herman, & Yingling, 2019) to perform a self-assessment regarding implicit bias. The IAT is offered by the Harvard University Implicit Project and can be accessed at https://implicit.harvard.edu.
  • Critical self-reflection among nursing faculty can be an effective tool to enhance nurse educators’ awareness regarding implicit bias (Koshy et al., 2017; Maksimović & Osmanović, 2019; Naicker & van Rensburg, 2018). Nursing educational organizations should encourage reflective practice among educators to enhance self-awareness.

Murray, T, A. (2017). Inclusive excellence in nursing education. Journal of Nursing Education, 56(10), 579-580. https://doi.org/10.3928/01484834- 20170918-01

Develop an Inclusive Pedagogy

Critical Pedagogy

Critical pedagogy encompasses how one teaches, what is being taught, and how one learns. It is a way of thinking about, negotiating, and transforming the relationship among a) classroom teachings, b) the production of knowledge, c) the institutional structures of the school, and the social and material relation of the wider community and society

Breunig, M. C., (2016). Critical and social justice pedagogies in practice. Encyclopedia of Educational Philosophy and Theory, DOI 10.1007/978- 981-287-532-7_234-1

Social Justice Pedagogy

Centered in democracy and the freedom to exercise one full humanity, social justice pedagogy practices seeing students for who they are, where they come from, and their valuable contribution to the teaching and learning environment.

https://www.edweek.org/teaching-learning/opinion-what-is-social-justiceeducation-anyway/2019/01

Antiracist Pedagogy

An approach that reveals the structural inequalities within U.S. society, while fostering students’ critical analysis skills and their critical self-reflection.

https://ctl.columbia.edu/resources-and-technology/resources/anti-racistpedagogy/

Culturally Responsive Pedagogy

A student-centered approach to teaching and learning where the student’s unique cultural strength is nurtured to promote student achievement and a sense of well-being about the student’s cultural place in the world.

https://www.theedadvocate.org/what-is-culturally-responsive-pedagogy/

Required Readings

View Required Readings [PDF]

Online Inclusive Teaching Strategies

Transforming Your Teaching for the Virtual Environment. The Harvard Macy Institute. https://harvardmacy.org/index.php/hmi-courses/ttve

Required Readings

View Required Readings [PDF]

Navigating Difficult Conversations

References

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Teaching about Race and Racism in the Classroom

Historical Perspectives

  • History of Race and Racism in the United STates
    • Washington, H. A. (2006). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York: Doubleday.
  • History of BIPOC nurses
    • Waite, R., & Nardi, D. (2019). Nursing colonialism in America: Implications for nursing leadership. Journal of Professional Nursing, 35(1), 18-25.
    • Beard, K. V., & Wrenetha, J.A. (2016). Does race still matter in nursing? The narratives of African American nursing faculty members. Nursing Outlook, 64(6), 583-596.
  • Hispanic Nurses
    • Chen, H. C., Jensen, F., Chung, J., & Measom, G. (2020). Exploring faculty perceptions of teaching cultural competence in nursing. Teaching and Learning in Nursing, 15(1), 1-6.
    • Gates, S. A. (2018, April). What works in promoting and maintaining diversity in nursing programs. In Nursing Forum, 53(2), 190-196.
    • Gonzalez-Guarda, R. M., Jones, E. J., Cohn, E., Gillespie, G. L., & Bowen, F. (2017). Advancing nursing science through community advisory boards: working effectively across diverse communities. ANS. Advances in Nursing Science, 40(3), 278.
  • American Indian/Alaska Native Nurses
    • Cech, E., Metz, A., Babcock, T., & Smith, J. (2011). Caring for our own: The role of institutionalized support structures in Native American Nursing Student Success. Journal of Nursing Education, 50(9), 524-531.
      • Keith, J., Stastny, S., & Brunt, A. (2016). Barriers and strategies for American Indian College Students: A Review. Journal of College Student Development; 57(6), 698-714.
      • Lowe, J., & Struthers, R. (2001). A conceptual framework of nursing in Native American culture. Journal of Nursing Scholarship, 33(3), 279-283.
      • Milne, T., Creedy, D., & West, R. (2016). Integrated systematic review on educational strategies that promote academic success and resilience in undergraduate indigenous students. Nurse Education Today, 36, 387-394.

Resources

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Address Diversity and Equity Topics

Faculty are responsible for preparing the future nursing workforce that will provide care for a population that is rapidly increasing in diversity. To provide high-quality, equitable care and reduce health disparities, nurses must be skillful in cultural awareness in order to practice cultural humility. Cultural competence has been a common term to describe how to improve cultural understanding, but it is important to distinguish that cultural humility and awareness is a continuous process fueled by change and ongoing learning.

Cultural Humility

Cultural Humility in health care describes a lifelong commitment to self-evaluation and critique, to re-dressing power imbalances and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations. [Source: Tervalon, M., & Murray-Garcia, J. (2014). The concept of cultural humility, Health Affairs, 33(7)]

Cultural Humility is a reflective process of understanding one’s biases and privileges, managing power imbalances, and maintaining a stance that is open to others in relation to aspects of their cultural identity that are most important to them. Cultural competency includes the commitment to practicing cultural humility.

Cultural Competence

Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. (Adapted from Cross, 1989)

Health Equity

Health Equity: Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.

View Health Equity Resources [PDF]

How to Incorporate Health Equity into Curriculum

  • Commit to the integration of content related to health equity and health equity related concepts throughout the curriculum.
  • Expand clinical education experiences outside of the acute care setting.
  • Develop interprofessional education initiatives that encourage collaboration and intergroup dialogue.
  • Focus on assessment skills such as motivational interviewing and empathic inquiry.
  • Integrate curricular content related to social justice, antiracism, and advocacy throughout the curriculum.
  • Increase curricular content related to history of race and racism in America.
  • Build structural competency to address policies, procedures, laws and practices.
  • Create intentional programs of service learning.

Adopted from Thorton, M., & Persaud, S. (2018). Preparing today’s nurses: Social determinants of health and nursing education. The Online Journal of Issues in Nursing.

View Social Justice Resources [PDF]

View Health Disparities and Inequities Resources Resources [PDF]

View Social and Structural Determinants of Health Resources [PDF]

View Structural Racism Resources [PDF]

Develop Cultural Competence/Humility

Since the publication of the 2002 Institute of Medicine Report, Unequal Treatment, there has been considerable momentum in research to address health disparities and to discover ways to improve health care provided to minority groups. Reducing disparities requires attention to the essential components of equitable, patient-centered, culturally appropriate high-quality care (Institute of Medicine: In the Nation’s Compelling Interest, 2003). Campinha-Bacote (2002) developed The Process of Cultural Competence in the Delivery of Healthcare Service model of care. The constructs of the model included cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters. Cultural desire is the desire to know and be skillful in cultural encounters.

Cultural awareness is the recognition of ethnocentrism and the potential for cultural imposition. Cultural knowledge includes information about health beliefs and practices, disease incidence and prevalence, and treatment efficacy. One develops skill using awareness and knowledge in providing holistic and culturally appropriate care. Nursing faculty are charged with educating the future. The following recommendations reflect those observable behaviors representing culturally appropriate care.

Cultural competence in practice is defined not by a discrete endpoint but as a commitment and active engagement in a lifelong process that individuals “enter into on an ongoing basis with patients, communities, colleagues and with themselves” (Tervalon & Murray-Garcia, 1998). Tervalon and Murray-Garcia posit that cultural humility is a more suitable goal than cultural competence.

The strategies and tools introduced in this section offer nursing faculty options in developing cultural competencies in order to practice with cultural humility. The nine cultural competency/humility statements serve as pathway in providing more culturally appropriate nursing care for a diverse population.

Cultural Competency 1

Apply knowledge of socioeconomic, environmental, and cultural, political, and technologic factors that affect nursing practice and healthcare across multiple contexts.

Sub-Competencies
  • Acquire and integrate knowledge about the cultures represented in the community being served, adapting care to meet client needs, and documenting assessment and adaptations.
  • Provide culturally tailored care (cultural awareness, skill, sensitivity, and humility) to diverse populations.
  • Use of culturally competent verbal and non-verbal communication skills for eliciting patients' beliefs and practices.
  • Recognize how unconscious and conscious biases undermine efforts to provide care to diverse populations.
  • Identify social determinants of health and discuss their influence on health and wellbeing.
  • Develop plans of care and community assessments that include but are not limited to cultural, structural, environmental, and political factors.

Cultural Competency 2

Integrate knowledge of perspectives, values, and practices of culturally diverse individuals, families and communities regarding healing traditions and systems.

Sub-Competencies
  • Uses culturally sensitive skills when planning and implementing person-centered care.
  • Integrates cultural awareness, cultural knowledge, and cultural skill in care delivery.
  • Demonstrates respect for a client’s values, beliefs, and practices.
  • Provide culturally responsive, patient-centered care that assesses and addresses social determinants of health.
  • Assess accurately and make appropriate adaptations to accommodate disparate patient circumstances.
  • Conducts cultural health assessments and provides cultural-specific care as determined by the individual conditions and needs.
  • Demonstrates awareness of personal implicit and explicit bias that may impact care delivery.

Cultural Competency 3

Engage with community stakeholders to work toward achieving equity in health and wellbeing.

Sub-Competencies
  • Consistently identify and address socioeconomic, environmental, and cultural factors in nursing care planning activities and interventions.
  • Engage with communities to assess healthcare needs of diverse populations and reduce health disparities.
  • Recognize how implicit bias impacts the health of individuals, families, communities, and populations.
  • Advocate for health equity.
  • Develop, engage, and reflect on community projects/partnerships to promote diversity, equity, and inclusion.
  • Engage multi-sector community resources to improve patient and population health outcomes.

Cultural Competency 4

Integrate fully, throughout the curriculum, evidence to provide just care.

Sub-Competencies
  • Examine cultural variations in healthcare values, beliefs, and practice in the provision of culturally appropriate care.
  • Engage in the evaluation of effectiveness of interventions for persons with unique health values, beliefs, and practices.
  • Identify, review, and synthesize diverse sources of data/evidence to gain multiple perspectives.
  • Participate in the access, collection, documentation, and use of cultural and social data to inform the delivery of care.
  • Use data to advocate for health equity for individuals/communities.
  • Identify gaps in data/evidence related to diverse and underserved populations.
  • Facilitate access to data resources and services to inform delivery of just care.
  • Critique existing research and knowledge sources to determine its relevance and applicability to diverse individuals, communities, and populations.
  • Consistently use Evidence Based Practice (EBP) tools to assess social determinants of health.
  • Utilize clinical practice guidelines and EBP to deliver quality care, (e.g., Healthcare Effectiveness Data and Information Set [HEDIS] metrics).

Cultural Competency 5

Promote safe, equitable, and quality outcomes of care inclusive of diverse populations

Sub-Competencies
  • Provide quality and safe care to minimize health disparities and implement culturally inclusive programs and services.
  • Recognize how social determinants of health impact quality and safety in complex healthcare systems.
  • Complete plans of study applying knowledge of social determinants of health and quality and safety in diverse populations.
  • Critique case studies that address implicit bias affecting quality and safety in diverse populations.
  • Engages in cultural encounters to assess linguistic needs of diverse populations.
  • Demonstrate respectful communication and cultural knowledge that increases agency of persons from diverse populations.
  • Evaluate plans of care demonstrating knowledge of social determinants of health, quality, and safety in diverse populations.
  • Engage in lifelong learning to improve health, quality, and safety in diverse populations.

Cultural Competency 6

Integrate the core principles of social justice into interprofessional practice as evidenced by engagement toward the elimination of health disparities and the attainment of health equity for all.

Sub-Competencies
  • Collaborate with interprofessional teams to deliver quality and safe care, minimize health disparities, and implement culturally inclusive programs and services.
  • Engage in a collaborative process with patients, families, the community, and the healthcare team to optimize outcomes and the care experience for diverse populations.
  • Work with other health professional teams and community stakeholders to resolve existing health disparities.
  • Examine and apply strategies to mitigate unconscious bias of team members in the delivery of healthcare services and its impact on care delivery.
  • Advocate for effective resources used by the interprofessional team to facilitate cross-cultural communication for diverse populations.
  • Communicate effectively with patients, families, the public, and within organizations across a broad range of socioeconomic and cultural backgrounds.
  • Collaborate with public, private, professional organizations, and communities to establish policies and guidelines for culturally competent care.
  • Recognize how the distribution of power, knowledge, and resources affect clients' ability to be a full partner on the care team.

Cultural Competency 7

Recognize how the distribution of power, knowledge, and resources affect clients' ability to fully access and utilize complex systems of health care.

Sub-Competencies
  • Analyze systems of care for strengths and areas for improvement in meeting the needs of diverse populations.
  • Advocate for a culturally competent system built on an awareness of the integration and interaction of health beliefs and behaviors, disease prevalence and incidence, and treatment outcomes for different patient populations.
  • Identify specific structural barriers, such as housing, transportation, education, social supports, insurance, and access to health care that affect health.
  • Engage in problem solving in order to remove structural barriers that affect health.
  • Incorporate the principals of social justice in systems of care.
  • Evaluate a system’s accessibility and use of informatics and technology from the perspective of promoting fairness, social justice, and equity and how it addresses the determinants of health.

Cultural Competency 8

Engage in critical self-assessment and reflection of one’s own values and beliefs to increase awareness of the impact on nursing care delivery.

Sub-Competencies
  • Define the concepts of diversity, equity, and inclusion as they apply to one’s personal philosophy of nursing.
  • Describe own cultural background, privilege, and biases.
  • Incorporate the principles of social justice into professional practice.
  • Conduct nursing practice that is consistent with the ethical principles as outlined in the ANA Code of Ethics for Nurses with Interpretive Statements.
  • Advocate for policies that promote fairness, social justice, and equity and that address the determinants of health.
  • Values the importance of bias on decision-making.
  • Recognize and report individual and institutional discrimination practices, unequal treatment practices, breaches of patients’ human and civil rights, or violations of respect for patient autonomy to appropriate authorities.

Cultural Competency 9

Engage in lifelong learning and leadership development to support principles of diversity, equity, and inclusion.

Sub-Competencies
  • Articulate the value of pursuing lifelong learning related to diversity, equity, and inclusion to foster personal and professional growth.
  • Engage in self-reflection about one’s own beliefs.
  • Recognize and manage the impact of bias through self-assessment and continuing education.
  • Demonstrate increased self-awareness of implicit bias during interaction with patients, families, and colleagues.
  • Demonstrate leadership in addressing behavior that is insensitive, lacks cultural awareness, or reflects prejudice in order to improve adherence to professional standards of respect, dignity, and civility.
  • Engage in a variety of activities to develop an enhanced understanding of diversity, equity, and inclusion to support both professional nursing practice development and personal growth.
  • Demonstrate insight and understanding into the broader influences of health disparities such as power differential, macroaggressions, privilege, implicit and explicit bias, stereotyping, and stigma.

Additional Resources for Classroom