Once thought of as a white woman’s profession, nursing is now more accepting of diversity, according to Yvonne Wesley, RN, PhD, adjunct associate professor at New York University’s College of Nursing, New York City.
"I think for today’s nurses, there’s a transcultural twist to everything," Wesley said. "So, no matter what you talk about, we have to talk about it as, 'What does this look like from a Filipino culture? What does this look like from a Korean culture? What does it look like from a Pakistani culture?’" Wesley said. "And there is a large push, whether in education or at the bedside, to be culturally competent."
Being culturally competent means more than being culturally sensitive, Wesley said. "We started with awareness. We went to sensitivity, and now we’re at competency," she said. "So, nurses are expected to be competent in other people’s cultures."
"It [has been] long known that culture is a determinant of access to healthcare, specific treatment modalities and healthcare decisions," said Martha J. Greenberg, RN, PhD, associate professor and chairwoman of undergraduate nursing at Pace University’s Lienhard School of Nursing, Pleasantville, N.Y. "Treatment and treatment responses to disease, morbidity and mortality are linked to memberships in cultural groups. Differences in positive health outcomes are disproportionately low in racial and ethnic minorities, and these differences lead to disparities in healthcare."
As a result, schools including Adelphi University in Garden City, N.Y., are updating undergraduate nursing curriculums to include more emphasis on cultural understanding, said Patrick Coonan, RN, EdD, FACHE, dean of nursing at Adelphi.
Pace offers two undergraduate courses on cultural competence. One, a nursing elective for four-year students, focuses on the major ethnic and cultural groups, as well as dominant American beliefs as they pertain to nursing and healthcare. Cultural Mindfulness, a required RN/BS course, focuses on the impact of culture and diversity in the delivery of nursing and healthcare to individuals, families, groups and the community, Greenberg said.
"Global health is a major component of our nursing curriculum at all levels — undergraduate, graduate and doctorate," said Muriel M. Shore, RN, EdD, NEA-BC, DPNAP, dean and professor at Felician College’s School of Nursing, Lodi, N.J. "Our more than 600 nursing students are exposed to patient populations with a variety of diverse cultures in New Jersey, regionally and internationally. Preparing students to care for a diverse patient population requires careful selection of clinical sites where they will practice under the supervision of their faculty. In the Geriatrics and Health Care course, students work together in culturally diverse pairs to make home visits and visits to houses of worship other than their own cultures."
Especially in culturally rich areas of New York and New Jersey, nursing students are more diverse than nurses in the workforce.
"When you get into the classroom now, I do sense that you’re seeing 20%, perhaps even 30% minorities in classrooms," Wesley said.
"There is a growing Hispanic population, but we’re not seeing a dramatic growth in Hispanic nursing students, although we’re trying hard to reach out to them," Coonan said.
According to nationwide statistics, minorities make up about 16.8% of the nursing workforce, according to data from the 2008 National Sample Survey of Registered Nurses. In the AACN’s report "2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing," nursing students from minority backgrounds represented 26.8% of students in entry-level baccalaureate programs, 26.1% of master’s students, and 23.3% of students in research-focused doctoral programs.
Nurses from minority backgrounds are more likely than white nurses to pursue baccalaureate and higher nursing degrees, according to the 2008 survey. Slightly more than 48% of white nurses complete nursing degrees beyond the associate degree level, compared to 52.5% of black nurses; 51.5% of Hispanics and 75.6% of Asians.
It helps that Johnson and Johnson, the Robert Wood Johnson Foundation and others are stepping in to fund recruitment efforts aimed at creating a more diverse nursing pool.
Universities also are doing their part to make a bigger melting pot of nursing students. Coonan said it helps to attract diverse students when the student body and faculty mirror diversity.
"Diversity gets diversity," he said. "I think you have to start that process early on and try and recruit your culturally diverse faculty in order to get your culturally diverse student population."
But attracting a diverse faculty is not easy. While Coonan said Adelphi has a diverse faculty, nursing educators representing minorities are hard to find. "At the doctoral level, there is a lot less diversity in the faculty, but the diversity among students in our PhD program is terrific," he said.
According to 2010 data from AACN member schools, 12.6% of full-time nursing school faculty come from minority backgrounds.
Approaches to teaching, Shore said, are evolving to accommodate diverse students’ learning needs.
"More students are first-generation college or second-career students, many combining the rigors of family and academics while some are head of households," she said. "Thus, faculty has had to adapt their teaching, advisement, scheduling and location of classroom to meet the needs of the students. Felician College is on the cutting edge in flexible scheduling, adapting locations to meet the needs of students, utilizing hybrid courses based on the skill set of the students and a rolling admission process."
Faculty are mindful of students from different backgrounds who might require language skills in speaking and writing English.
"In addition to students taking English and composition writing classes, faculty have been more conscious of test construction in terms of the language they use," Shore said. "They try and eliminate phrases that may be more ethnocentric and not universal."
Keeping on track to not only teach diversity, but attract diverse student and faculty populations is vital, according to Coonan.
"The importance, quite frankly, is really simple," he said. "For those who have not looked around the world, especially around our New York Metro area, it is an incredibly diverse population. And it is going to continue to be that way. So, if we can turn out and educate a diverse nursing population, then patients will ultimately get better care. The cultures will be understood better."
Lisette Hilton is a freelance writer.
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