Journal of Nursing Education

EDITORIAL 

Promoting Culturally Competent Nursing Education

Joy C Princeton, PhD, RN, FAAN

Abstract

Over the past several decades, the image of our society as a melting pot has given way to the reality that the United States is, in fact, a pluralistic nation, one in which multiculturalism and cultural diversity prevail. Various academics have addressed and debated educational issues and implications related to population pluralism, but none has been more heated and controversial than the recent debate over Bloom's Closing of the American Mind (1987). Hundreds of scholars have published accolades in support of Bloom's theses, while nearly as many have been highly critical, with some calling him elitist, sexist, and racist. Books have been published that contain essays on how institutions of higher education should treat the challenges that Bloom presents, especially his argument that the radical egalitarianism and cultural relativism sweeping our educational institutions encourages separation of individuals (Bloom, 1988).

Regardless of the controversy over Bloom's work, there are numerous academics and practicing professionals in nursing and other disciplines who continue to believe that course work on cultural diversity must be included in their respective curricula. Consequently, a steadily growing literature has been developed delineating specific content relevant to multiculturalism that should be covered in nursing programs, and teaching strategies used that facilitate students' learning about and, subsequently, their care of people from diverse cultures. Much of what nurses write about, however, consists of information from other disciplines, such as anthropology, which is adapted to nursing. Thus, at present the nursing literature is largely anecdotal and experientially based rather than based on nursing research.

A few years ago, the American Nurses Association's (ANA) Council on Cultural Diversity in Nursing Practice published a booklet, entitled "Cultural Diversity in the Nursing Curriculum: A Guide for Implementation" (1986), in which the broad purpose and objectives of culturally diverse curricula were set forth. Specific strategies for developing a curricular philosophy and goals were also identified, as well as four major approaches that may be taken to include content on cultural diversity in nursing programs.

Yet, according to the American Academy of Nursing's (AAN) Expert Panel on Cultural Competence in Nursing Education (1992a):

In the 1990s, slightly less than 25% of the U.S. schools of nureing offer a substantive cross-cultural nursing course in (their) undergraduate program; only 8% of the (master's) students have a graduate course on this subject; and less than 2% of nursing students enrolled in doctoral programs in nursing have a full seminar focused on cross-cultural nursing or culture diversity (pp. 32-33).

... All too frequently, nursing students get "bits and pieces" of culture ideas often out of context or superficial culture content that often leads to misunderstandings, inadequate information to make clinical judgments, and inaccurate knowledge for their learning experiences . . . nursing education continues to be largely unicultural in values, in teaching content, and in clinical experiences (p. 33).

One of the most pressing problems confronting faculty in nursing schools is how to present and discuss content on cultural diversity without stereotyping, without misleading students about the vitally important individual and small-group variations that occur within any larger cultural group.

Faculty would do well to take the Panel's observations as challenges rather than criticisms, as opportunities to work together to assure that specific courses on cultural diversity and culturally competent nursing care are planned into their schools' curricula. (Note that the term culturally competent care is replacing culturally sensitive care, as the latter term no longer accurately reflects the level of expertise needed by nurses who practice in our pluralistic nation). To rely totally on integrating this content into ongoing courses that are customarily offered in nursing programs will no…

Over the past several decades, the image of our society as a melting pot has given way to the reality that the United States is, in fact, a pluralistic nation, one in which multiculturalism and cultural diversity prevail. Various academics have addressed and debated educational issues and implications related to population pluralism, but none has been more heated and controversial than the recent debate over Bloom's Closing of the American Mind (1987). Hundreds of scholars have published accolades in support of Bloom's theses, while nearly as many have been highly critical, with some calling him elitist, sexist, and racist. Books have been published that contain essays on how institutions of higher education should treat the challenges that Bloom presents, especially his argument that the radical egalitarianism and cultural relativism sweeping our educational institutions encourages separation of individuals (Bloom, 1988).

Regardless of the controversy over Bloom's work, there are numerous academics and practicing professionals in nursing and other disciplines who continue to believe that course work on cultural diversity must be included in their respective curricula. Consequently, a steadily growing literature has been developed delineating specific content relevant to multiculturalism that should be covered in nursing programs, and teaching strategies used that facilitate students' learning about and, subsequently, their care of people from diverse cultures. Much of what nurses write about, however, consists of information from other disciplines, such as anthropology, which is adapted to nursing. Thus, at present the nursing literature is largely anecdotal and experientially based rather than based on nursing research.

A few years ago, the American Nurses Association's (ANA) Council on Cultural Diversity in Nursing Practice published a booklet, entitled "Cultural Diversity in the Nursing Curriculum: A Guide for Implementation" (1986), in which the broad purpose and objectives of culturally diverse curricula were set forth. Specific strategies for developing a curricular philosophy and goals were also identified, as well as four major approaches that may be taken to include content on cultural diversity in nursing programs.

Yet, according to the American Academy of Nursing's (AAN) Expert Panel on Cultural Competence in Nursing Education (1992a):

In the 1990s, slightly less than 25% of the U.S. schools of nureing offer a substantive cross-cultural nursing course in (their) undergraduate program; only 8% of the (master's) students have a graduate course on this subject; and less than 2% of nursing students enrolled in doctoral programs in nursing have a full seminar focused on cross-cultural nursing or culture diversity (pp. 32-33).

... All too frequently, nursing students get "bits and pieces" of culture ideas often out of context or superficial culture content that often leads to misunderstandings, inadequate information to make clinical judgments, and inaccurate knowledge for their learning experiences . . . nursing education continues to be largely unicultural in values, in teaching content, and in clinical experiences (p. 33).

One of the most pressing problems confronting faculty in nursing schools is how to present and discuss content on cultural diversity without stereotyping, without misleading students about the vitally important individual and small-group variations that occur within any larger cultural group.

Faculty would do well to take the Panel's observations as challenges rather than criticisms, as opportunities to work together to assure that specific courses on cultural diversity and culturally competent nursing care are planned into their schools' curricula. (Note that the term culturally competent care is replacing culturally sensitive care, as the latter term no longer accurately reflects the level of expertise needed by nurses who practice in our pluralistic nation). To rely totally on integrating this content into ongoing courses that are customarily offered in nursing programs will no longer meet the mark. Furthermore, cultural diversity must be broadly defined, not limited to the traditionally defined minority groups, i.e., Asians, Hispanica, Native Americans, or Blacks. Rather the term should include, for example, women as a minority group and their issues; men in nursing as minorities and their related issues; and groups of people who have different lifestyles from the dominant population due to religious beliefs, employment status, sexual orientation, and so forth.

Efforts are currently underway by various nursing organizations to promote multiculturalism in nursing school curricula, e.g., the diligent work over the past several years by the AAN's Expert Panel (1992b) from whom specific recommendations and strategies will be forthcoming regarding nursing education (see the November/ December issue of Nursing Outlook). The American Association of Colleges of Nursing specifically addresses the need to recognize cultural diversity by targeted student recruitment strategies, faculty preparation, and specific and distinct curricular content and processes (1992).

The National League for Nursing (NLN) recently published an agenda to reform nursing education (1992a) in which there is a call for curricular innovations, including a plea to pay "special attention to the multiracial and growing diversity of both individual and family lifestyles" (p. 8). Likewise, one strategic direction for the Department of Health and Human Services (DHHS) Division of Nursing (Salmon, 1993) is "enhancing racial and ethnic diversity and cultural competency in the nursing workforce," which begins with nursing education programs. And, certainly, other organized groups of professional nurses are working toward this end, such as the Council on Nursing and Anthropology of the American Anthropological Association, and the Transcultural Nursing Society, as well as the ANA's Council on Cultural Diversity.

Perhaps this will be the key to success: That several large and powerful nursing organizations work on a common goal, which in this case is to guarantee that specific courses on cultural diversity are included in nursing education programs. These concerted efforts are very welcome and needed, and they are really quite different from the past when faculty most often worked by themselves, in dyads or small groups, to voice their concerns and questions about cultural diversity in nursing curricula and to recommend various teaching and learning strategies.

Another positive outcome of the organizational efforts is the emphasis on the need for nursing research to examine the "what," "when," "where," "who," and "how* questions relevant to educating nursing students about cultural diversity and culturally competent nursing care. A recent review of the literature revealed that, while considerable descriptive research has focused on culturally competent nursing care, there is a dearth of research focused on culturally competent nursing education.

Pressing and continuous concerns for nursing school faculties are the recruitment and retention of nursing students from racial/ethnic minority backgrounds. The federal government has suggested that one factor related to the poorer health status among racial/ethnic minority populations may be that consistently, there have been small numbers of minority health care providers in comparison to the size of their total population (DHHS, 1991). Recent statistics tend to confirm this factor. For example, of all students enrolled in basic collegiate nursing programs, only about 18% are from minority backgrounds (NLN, 1992a); 11.1% Black, 3% Asian, 3.2% Hispanic, and 0.6% American Indian. These figures closely parallel national averages for minority students enrolled in institutions of higher education. About 12% of students enrolled in master's programs are members of a minority group, with 5.3% Black, 3.3% Hispanic, 2.6% Asian, and 0.5% American Indian (NLN, 1992b). These numbers become even more alarming when we note that only 8.8% of nursing school faculty throughout the nation are from racial/minority backgrounds (NLN, 1992c).

Thus, the need to recruit and retain minority students into undergraduate and graduate nursing programs is clearly evident, not only to serve in nursing practice arenas but to serve as faculty in the approximately 1,470 nursing schools throughout the nation. Authors writing in , this issue of the Journal of Nursing Education address problems encountered when recruiting and retaining minority students, and they present strategies that have been effective in working with these problems. Other faculty will benefit from these experiences.

The Journal of Nursing Education should be lauded for this timely issue on multiculturalism and cultural diversity in nursing education. The articles contribute to OUT knowledge base as educators and will help us to identify further areas for nursing educational research. For example, research is needed that compares the outcomes of different curricular models for nursing programs that offer courses in cultural diversity; that compares different approaches for recruiting, retaining, and teaching students from culturally diverse groups; and that identifies the outcomes of students' clinical practice experiences with culturally diverse clients, the practice of which is based on the students' program of studies. Faculty in nursing programs throughout the nation are positioned to provide the leadership in meeting these curricular and research challenges. Let's do it!

References

  • AAN Expert Panel on Culturally Competent Health Care (1992a). Executive summary, priorities and recommendations, and report. Washington, DC: Author.
  • AAN Expert Panel on Culturally Competent Health Care (1992bX Culturally competent health care. Nursing Outlook, 40, 277-283.
  • American Association of Colleges of Nursing (1992). Position statement for addressing nursing education's agenda for the 21st century (draft). Washington, DC: Author.
  • ANA Executive Committee of the Council on Cultural Diversity in Nursing Practice (1986). Cultural diversity in the nursing curriculum. A guide for implementation. Kansas City, MO: ANA.
  • Bloom, A. ( 1987). Closing of the American mind. New York: Simon & Schuster.
  • Bloom, A. (1988). Tbo much tolerance. New Perspectives Quarterly, 4, 6-13.
  • DHHS, Health Resources and Services Administration. (1991). Health personnel in the United States: Eighth report to Congress. Washington, DC: U.S. Government Printing Office.
  • National League for Nursing (1992a). An agenda for nursing education reform in support of nursing's agenda for health care reform. New York: Author.
  • National League for Nursing (1992b). Nursing datasource 1992: Leaders in the making: Graduate education in nursing. New York: Author.
  • National League for Nursing (1992c). Nursing data review 1992. New York: Author.
  • Salmon, M.E. (1993). Report to the council for the society for research in nursing education llth annual meeting. (Working draft, DHHS, PHS, HRSA, Division of Nursing strategic directions). Washington, DC: U.S. Government Printing Office.

10.3928/0148-4834-19930501-03

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