Running head: DIVERSITY IN NURSING EDUCATION 1

Diversity in Nursing Education

Denise M. Preston

Ferris State University

DIVERSITY IN NURSING EDUCATION 2

Abstract

This paper addresses the increasing need for nursing educators to hold teaching diversity, and

inclusiveness at a vitally important level, during nursing education. It lists various facets of

diversity that are important topics in todays nursing profession. The need is expanding for

diversity to be addressed in nursing education, due to the ever-growing awareness of disparities.

There is discussion of possible positive effects of cultural competency, and negative effects due

to lack of competency. This discussion of effects involves the nurses, and patients, the health-

care systems, and facilities. Links are made in this paper between, being skillful in addressing

cultural needs, with the quality of health-care received by patients, the satisfaction of health-care

workers, with the end product of a more successful health-care system. Finally, the impact on

the health-care system itself is discussed. Cultural inclusiveness education is talked about, in

relation to concepts of a complex system, and nursing leadership.

Keywords: diversity, nursing, education, cultural competency

DIVERSITY IN NURSING EDUCATION 3

Diversity in Nursing Education

The purpose of this paper is to address the increasing need for nursing educators to

augment counsel in diversity and inclusiveness in nursing education. Diversity has many facets.

It can include: religion, language, size, gender, sexual orientation, age, disability, politics

occupation, or socio economic status (Campinha-bacote, 2003). This list is not an end product,

as the list continually grows when more areas that need addressing emerge. Competence in

cultural diversity, and values is a must for todays nurse to effectively treat patients and engage

productively with co-workers.

Support in the System

The appreciation of cultural variation is better addressed at the early stages of nursing

education (Bendarz, 2010), before biases surface, and increase. This cultural awareness should

continue throughout the educational process. These biases, if carried over into the health care

facility, can affect the quality of health care at a system wide level, according to the National

League for Nursing (Achieving diversity and meaningful inclusion in nursing education, 2016).

Teaching self-awareness, and respect for others values (Achieving diversity and meaningful

inclusion in nursing education, 2016), connects with the Butterfly Effect of systems theory.

Being aware of a cultural variance, even if small, in a peer or patient, and relating to that could

raise their self-esteem, enhance a patient stay, and strengthen a relationship (Yoder, 2001)

(Crowell, 2015). Thus, a seemingly small act can increase the quality of the work environment

(Crowell, 2015), and, increase patient and worker satisfaction. This knowledge and sensitivity

has the potential of touching every person in every sector of the work place, as we live in an ever

increasing culturally diverse world. To meet this need, we instruct future nursing leaders.

Teaching leaders increases the need for this education even more, as they will be the role model
DIVERSITY IN NURSING EDUCATION 4

in forging trusting relationships with workmates, and patients in the system (Marshall, 2017),

and cultivating the vision of cultural competency (Calvillo, 2009). This vision, while increasing

the quality of the workplace, and the satisfaction of all involved will ultimately increase the

financial aspect of the hospital, as the payments from insurances are now, also, based on the

quality of the care rendered (Yoder, 2001).

Need for Change

Nurses spend more time with patients than any other health care provider (Calvillo,

2009). Most nurses are conscientious by nature. It is safe to assume, nurses would aspire to give

each patient, the best experience possible. The nurse must give educational, and discharge

instructions, get food, see to patient comfort and dispense medications. In order to complete

these tasks with a patient of a different culture, the nurse needs an education that gives first-hand

experience with patients of different cultures (Calvillo, 2009). It is also suggested that the nurse

learn a foreign language. This is so the nurse is empathetic to those who are learning English

while attending college, and are on the outside of a culturally dominant group (Calvillo, 2009).

The need for a level of expertise in interacting with those of a different culture in the

work force is evident by the number of non -traditional nursing students there are. It is estimated

that 73% of the total of undergraduate nurses are non-traditional (Bendarz, 2010). These people

are trying to learn a profession, possibly in a different language, in a system that could be vastly

different from the value, and hierarchy system they were accustomed to in their own culture

(Yoder, 2001). This can translate into difficulty staying motivated, low test scores, and feelings

of isolation, as a student. Then, after graduation, there may be a lack of preparedness of the new

nurse to effectively contend with the demands of the profession (Torregosa, 2012).
DIVERSITY IN NURSING EDUCATION 5

Nurses that are not aware of different cultural aspects, and cues of patients can be a cause

of disparity in the healthcare system. The result of lack of preparedness, is a potential patient of

the non dominate culture, who is hesitant to seek care, due to the lack of clinicians they can

relate to (Achieving diversity and meaningful inclusion in nursing education, 2016). This could

lead to greater health problems, and an emergent situation that would be even more stressful for

the patient. This is also a major factor in patient dissatisfaction, and perceived low quality of

care, due to communication difficulties with their language, and cultural practices, and beliefs

(Yoder, 2001).

Systems Impact

The above issues involve such a large human portion of the health care field, that it has the

ability to hinder the potential of the system, if not adequately addressed. If the student nurses do

not effectively learn to skillfully address diverse situations, they limit their areas of practice.

Specific communities need culturally aware nurses to bond and relate to the population (Tulman,

2008). Hospitals need nurses, at all levels, that can appreciate the differences in culture, and find

a way to accommodate that difference by negotiating, or mentoring if the issue is not negotiable

(Bendarz, 2010). An individuals cultural concern would be a part of the complex system as an

emergent situation (Crowell, 2015). If the nurses or patients cultural needs were not supported

in some fashion, then there will be dissatisfaction, and quality impacts. If, a non-linear approach

is taken, and the cultural topic addressed, it could mean a positive outcome and evidence of

transformational leadership in progress (Marshall, 2017). Then, by healthcare standards today, the

rise in quality satisfaction should translate to meeting standards set by insurance payers, and more

payments will be made to the institution. By keeping to the simple rules of the complex system
DIVERSITY IN NURSING EDUCATION 6

(safety, effectiveness, efficiency and equitable care), in an environment whose core is the patient,

the system should respect the patients wishes for cultural inclusion (Crowell, 2015).

Conclusion

Todays nursing educators must keep the many, and ever-changing facets of cultural

diversity in the forefront of the nurses education experience. The nurse, and nursing leadership,

must be taught to reflect on and clear their own biases, so, they can move forward in being

respectful, and sensitive to the cultural needs of patients and co-workers. This builds trust, and

adds to the quality and satisfaction of the patient experience, and the workmates job

gratification. It is an essential component of transformational leadership, and will elevate the

system and organization to a more excellent level (Marshall, 2017).

The need to be ever diligent in the quest for cultural inclusiveness, and competency is

evident in the increasing number of non traditional nurses going into the field of nursing

(Bendarz, 2010). Their needs, if not accounted for, could have a major effect on the work

environment. Added to the large groups of non-traditional nurses, are more diverse groups of

patients, coming in with health issues. These patients, now expect a higher level of care, which

includes, addressing the cultural aspects of their lives (Crowell, 2015).

If we keep this important subject in the focus of education, we can pass it on in practice.

We will then increase the value of our health system. This will be accomplished by, boosting the

quality of patient care, increasing job satisfaction, and keeping the facilities scores high for

reimbursement. It is an overall winning situation to teach nurses cultural competency.

DIVERSITY IN NURSING EDUCATION 7

REFERENCES

Achieving diversity and meaningful inclusion in nursing education. (2016, February). Retrieved

from National organization of nurses with disabilities:

http://www.nond.org/resources/NLN-vision-statement-achieving-diversity.pdf

Bendarz, H. S. (2010). Cultural diversity in nursing education: perils, pitfalls and pearls. Journal

of Nursing education, 253-260.

Calvillo, E. C. (2009). Cultural competency in baccalaureate nursing education. Journal of

transcultural nursing, 137-145.

Campinha-bacote, J. (2003). Many faces: addressing diversity iin health care. The online journal

of issues in nursing.

Crowell, D. (2015). Complexity in leadership. Philadelphia, PA: F.A. Davis Company.

Marshall, S. (2017). Transformational leadership in nursing. . New York, NY: Springer.

Torregosa, M. &. (2012). Programmatic and teaching initiatives for ethnically diverse nursing

students: a literature review. Asian nursing research, 67-74.

Tulman, L. &. (2008). Development and testing of the blueprint for integration of cultural

competence in the curriculum questionnaire. Journal of professional nursing, 161-166.

Yoder, M. (2001). The bridging approach: effective strategies for teaching ethnically diverse

nursing students. Journal of transcultural nursing, 319-325.