CULTURAL SENSITIVITY IS CHARACTERIZED BY OPENNESS TO DIVERSITY,
WITH MUTUAL RESPECT AND TRUST FOR OTHERS. LIKE EDUCATORS IN OTHER
FIELDS, nurse educators need to be prepared to teach in multicultural
settings, providing equal learning opportunities for all students.
Despite calls by the National League for Nursing (2008) to increase the
diversity of the nursing workforce, many programs to teach educators do
not prepare them to teach students from cultural backgrounds different
from their own.
A culturally sensitive manner of teaching that respects the
differences of all who choose to become nurses will improve recruitment
and retention of students. As the Sullivan Commission (2004) pointed
out, "Excellence in health professions education is difficult to
achieve in a culturally limited environment" (p. 6). The commission
stressed that "for minority students, institutional climate exerts
a profound effect on the quality of the educational experience and
directly influences a student's sense of comfort and security"
Methods Using the Delphi technique, which calls on experts'
opinions to answer research questions, a list was developed of best
practices that promote cultural sensitivity in nursing education and
nursing practice (Dewald, 2010). Using a three-tiered format, 12 experts
responded to questionnaires that evolved from their professional
experiences. The experts were asked: "What teaching strategies or
practices promote culturally sensitive learning environments for student
nurses?" and "What teaching strategies or practices promote
culturally sensitive nurses?"
The first tier of the study encompassed a qualitative analysis of
teaching strategies and practices that the experts have found to promote
cultural sensitivity in nursing education. Responses were coded and
categorized and then used as items in the next two tiers of the study.
The second questionnaire used a quantitative analysis of these items,
which participants ranked in importance on a five-point Likert-type
scale. The result was analyzed using central tendency statistics,
specifically, means and standard deviations. After reading the responses
and comments of the other panelists, the participants were asked to
rethink their previous responses and again rank the items, this time
using a three-point Likert-type scale (l = not important, 2 = somewhat
important, 3 = very important) to develop recommended best practices for
Purposeful sampling was used for the selection of participants.
Regional chairpersons of the Sigma Theta Tau International Honor Society
of Nursing nominated individuals who demonstrated: expert knowledge and
skills in the teaching of nursing; knowledge and skills in clinical
nursing practice; continued professional interest; evidence of expertise
in culturally sensitive nursing and the teaching of nursing through
writing, teaching, and community service; and peer recognition or other
forms of recognition in nursing.
Panelists were recruited from geographically diverse areas of the
United States to use maximal variation sampling within a homogeneous
sample. The purpose was to bring together a group of experts into a
"virtual boardroom" to explore a variety of teaching methods
found useful in promoting cultural sensitivity. The goal was to promote
the sharing of ideas without bias and a potential imbalance of opinions.
Results The responses from Round 1 helped create a list of 91
strategies and practices. These were organized into categories
identified and synthesized from the data and verified by an independent
research consultant for accuracy. The Table lists categories in order of
their rated importance according to the highest mean scores and standard
deviations. Under each listed category, related strategies and practices
are also listed in order of rated importance.
Discussion The strategies and teaching practices recommended by the
nursing education expert participants are grounded in practice. The
strategies were then ranked by the same experts according to importance
or value in promoting a culturally sensitive learning experience.
However, whether using these strategies improves learning outcomes,
recruitment, and retention for culturally diverse nursing students
requires further exploration.
Baker (2010), concerned with the retention of minority students in
nursing programs, asked faculty to rate the effectiveness of strategies
used to promote retention in their programs. Faculty rated faculty
availability, financial assistance, belonging to clubs or organizations,
using faculty/staff tutors, and timely feedback as the most used and
most effective teaching practices to promote retention. Baker stressed
that student persistence depends highly on success, and success depends
on faculty understanding, mentoring, and support.
Using a mentoring, tutoring, and advisement approach to retain
diverse students, Robinson and Niemer (2010) found improved outcomes,
evidenced by increased retention and improved success on the NCLEX-RN[R]
exam. Williams (2010) described four themes related to minority student
persistence in nursing programs: keeping up, not giving up, doing it,
and connecting. Connecting included strong ties among family and
friends, faculty who showed concern and support, faculty who cared about
student success, personalization, and participation in student
The role of faculty has been shown to be a vital aspect of
retaining diverse students and improving outcomes. Nnedu (2009)
successfully used strategies such as student contacts, tutorials,
seminars, counseling, support groups, audio/visual aids, videotaped
lectures, study guidelines, adding cultural content to the curriculum,
advising, and mentoring to improve retention. Using
Campinha-Bacote's model, the nursing program provided faculty
development programs focused on improving faculty cultural competence
and enhancing student learning. The program experienced 100 percent
retention when these strategies were used.
Wilson, McKinney, and Rapata-Hanning (2011) found that student
outcomes improved when students had faculty support and encouragement,
groups for learning and support, and a culturally safe learning
environment. Included in a culturally safe learning environment was an
affirmed and valued cultural identity, approachability of faculty,
understanding the learning needs and experiences of students, respect,
access to role models, cultural content in the curriculum, and clinical
practice with diversity experiences.
Many of the recommended strategies that promote a culturally
sensitive learning environment, made by experts in this Delphi study,
have led to improved outcomes for diverse nursing students (Baker, 2010;
Robinson & Niemer, 2010; Williams, 2010; Wilson et al., 2011). It is
imperative that nursing research focus on teaching practices and
strategies aimed at improving cultural sensitivity with regard to
learning outcomes and retention of diverse students.
Conclusion Educators and health care providers must prepare for
changes in the nursing student population, with greater emphasis on
personalization, empowerment, caring, and cultural sensitivity. Sheets
(2003) stated that it takes more than admirable intentions to prepare a
culturally sensitive workforce: "While we currently may have the
ability to inspire, we have not demonstrated the capacity to educate a
professorate who can prepare pre-service candidates to succeed in
diverse settings" (p. 117). Nurse educators have been charged with
creating positive learning environments for a diverse student
population, but how to achieve that is not entirely clear.
The results of this research add knowledge that supports a
professorate prepared for teaching and retaining all nursing students
and creating environments that promote success. The expert panelists in
this Delphi study provided a list of practices that have worked for
them. By using their recommended best practices, nursing education can
begin to promote cultural sensitivity in nursing education and nursing
About the Author Robin J. Dewald, PhD, RN, CNE, is a faculty
program director at Excelsior College Department of Graduate Nursing,
Albany, New York. Contact Dr. Dewald at email@example.com.
Baker, B. H. (2010). Faculty ratings of retention strategies for
minority nursing students. Nursing Education Perspectives, 31 (4),
Dewald, R.J. (2010). Teaching strategies and practices that promote
a culturally sensitive nursing education:A Delphi study (Doctoral
dissertation, Capella University). Retrieved from www.proquest.com. (UMI
National League for Nursing. (2008). Nursing data review. Academic
year 2005-2006 executive summary. Retrieved from
Nnedu, C. (2009). Recruiting and retaining minorities in nursing
education. ABNF Journal, 20(4), 93-96.
Robinson, E., & Niemer, L. (2010). A peer mentor tutor program
for academic success in nursing. Nursing Education Perspectives, 31 (5),
Sheets, R. H. (2003). Competency vs. good intentions: Diversity
ideologies and teacher potential. International Journal of Qualitative
Studies in Education, 16(1), 111-120.
Sullivan Commission. (2004). Missing persons: Minorities in the
health professions. Retrieved from
Williams, M. G. (2010). Attrition and retention in the nursing
major: Understanding persistence in beginning nursing students. Nursing
Education Perspectives, 31 (6), 362-367. doi:10.1043/1536-5026-31.6.362
Wilson, D., McKinney, C., & Rapata-Hanning, M. (2011).
Retention of indigenous nursing students in New Zealand: A
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Nursing Profession, 38(1/2), 59-75.
Table. Best Practices that Promote a Culturally Sensitive
Category Mean/SD Teaching Practices and
Modeling 3.00/.000 Model culturally sensitive
nursing and respect
Respect 3.00/.000 Teach respect for human dignity
Communication 2.80/.422 Avoid acronyms and slang,
Use understandable dialogue
Caring 2.80/.422 Convey genuine empathy
Include cultural perspectives
of caring in curriculum
Clinical 2.00/.422 Expose students to a variety
of diverse patients
thinking and action
Self-Reflection 2.80/.632 Help students examine
attitudes, beliefs, reactions
Empowerment 2.70/.483 Encourage self-confidence,
Personalization 2.60/.516 Work with individual students
to overcome learning barriers
Teach students, not subjects
Recruitment 2.58/.669 Recruit culturally
Recruit diverse students
Support 2.50/.527 Provide tutoring and referrals
Resources 2.43/.535 Use available and agreed
Faculty 2.40/.516 Avoid generalizations and
Integrate cultural sensitivity
in all coursework
Classroom 2.40/.516 Use case reviews, scenarios,
and/or role play