Académique Documents
Professionnel Documents
Culture Documents
Denise M. Preston
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
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
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
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
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
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
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
REFERENCES
Achieving diversity and meaningful inclusion in nursing education. (2016, February). Retrieved
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
Campinha-bacote, J. (2003). Many faces: addressing diversity iin health care. The online journal
of issues in nursing.
Torregosa, M. &. (2012). Programmatic and teaching initiatives for ethnically diverse nursing
Tulman, L. &. (2008). Development and testing of the blueprint for integration of cultural
Yoder, M. (2001). The bridging approach: effective strategies for teaching ethnically diverse