Teaching strategies that promote a culturally sensitive nursing education.
Teachers (Recruiting)
Nursing education
Dewald, Robin J.
Pub Date:
Name: Nursing Education Perspectives Publisher: National League for Nursing, Inc. Audience: Academic; Professional Format: Magazine/Journal Subject: Education; Health; Social sciences Copyright: COPYRIGHT 2012 National League for Nursing, Inc. ISSN: 1536-5026
Date: Nov-Dec, 2012 Source Volume: 33 Source Issue: 6
Event Code: 280 Personnel administration Computer Subject: Industry hiring

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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" (p. 83).

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 educators.

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 organizations.

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 practice.

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 rdewald@excelsior.edu.


Baker, B. H. (2010). Faculty ratings of retention strategies for minority nursing students. Nursing Education Perspectives, 31 (4), 216-220.

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 No. 3390337)

National League for Nursing. (2008). Nursing data review. Academic year 2005-2006 executive summary. Retrieved from www.nln.org/research/datareview/executive_summary.pdf

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), 286-289.

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 http://health-equity.pitt.edu/40/1/Sullivan_Final_Report_000.pdf

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 cross-sectional survey. Contemporary Nurse: A Journal for the Australian Nursing Profession, 38(1/2), 59-75.
Table. Best Practices that Promote a Culturally Sensitive

Nursing Education

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
                              and translators
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
                              Use culturally
                              sensitive mentors
                              Promote critical
                              thinking and action
Self-Reflection   2.80/.632   Help students examine
                              attitudes, beliefs, reactions
Empowerment       2.70/.483   Encourage self-confidence,
                              promote self-efficacy
Personalization   2.60/.516   Work with individual students
                              to overcome learning barriers
                              Teach students, not subjects
Recruitment       2.58/.669   Recruit culturally
                              sensitive mentors
                              Recruit diverse students
                              and faculty
Support           2.50/.527   Provide tutoring and referrals
Resources         2.43/.535   Use available and agreed
                              upon resources
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
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