Guest Contributor: Danielle Brochu

Growing up in a community where there were two students of color in a high school of about 500 students total, moving away to university was an eye-opening experience for me, especially in regard to diversity. Even in my undergraduate years, the nursing student body was composed of about 90% young white women. It wasn’t until I entered my graduate studies as an aspiring nurse educator that I began to dive into the importance of diversity in nursing, particularly in the classroom and clinical settings, and be immersed in a truly diverse classroom setting myself. Now as a full-time clinical nurse educator, I’m encouraged to see the drastic increase in diversity among today’s pre-licensure BSN students in terms of greater rates of acceptance and program completion for men and people of color. However, we still have a long way to go before the nursing student body as a whole is truly reflective of the populations they work with, which is a critical step in the promotion of health equity. 

It wasn’t until the murder of George Floyd in 2020 and the subsequent socio-political fallout that I, like many other white people, began to seriously consider my own role in systemic racism and ignorance of injustice within our healthcare system, our nation, and our world. This was also around the time that I picked up Robin DiAngelo’s White Fragility: Why it’s so hard for white people to talk about racism, a book that led me to some intense self-reflection that shapes the way I teach, work with patients, and interact with people from various backgrounds.

Nursing students should feel empowered to learn and respected as their authentic selves by those who teach them. Chinn and Falk-Rafael’s Critical Care Pedagogy closely relates to how I teach my nursing students in didactic and clinical settings. By the nature of the nursing profession’s philosophical underpinnings, the education of future nurses should follow the same tenants of holistic caring that empower students to perform at their highest potential. Although there are several major concepts within Critical Care Pedagogy, the ideas of praxis, empowerment, awareness, cooperation, and evolvement relate the most to fostering diverse thought among diverse people. This transitions to the second nursing theory within this framework that I utilize when supporting nursing students, Chinn’s Peace and Power. Within the context of nursing education, this theory allows individual or groups of students to resolve misunderstanding or conflict, promote growth, and minimize adverse events or experiences.

Supporting a more diverse nursing workforce that is reflective of our patient populations will contribute to health equity across systems that directly impact patient experiences from inpatient, outpatient, and community care. Here are five ways that nursing educators can support diverse clinical groups for nursing students or new graduate nurse cohorts:

• Develop your own professional and personal cultural competence. Reading books, blogs, and reliable articles authored by people from marginalized communities can offer perspectives from those who are affected by various forms of oppression. Surrounding yourself with the voices of those who experience life differently from you can broaden your point of view to a more global perspective.
  
• Review differences in wound detection among diverse populations. Changes in skin integrity such as deep tissue injuries can be more difficult to detect in patients with darker skin pigment, which is something that many textbooks and educational programs fail to highlight (Oozageer et. al, 2021). For didactic teaching, set up a mini lecture on this topic to educate students on the subtle but important differences in wound identification for people of color, or incorporate it as a significant portion of an existing lecture on integumentary assessment, for example in a basic med-surg course. For the clinical setting, pairing students with a wound nurse specialist, if possible, would allow opportunity for assessing a wide variety of patient skin types.
  
• Ensure that students are caring for diverse patients. Prior to graduation, each student should feel comfortable caring for patients from various races, cultures, religious backgrounds, sexual orientations, and communities different from their own. Making sure that they have encounters with patients from various backgrounds will help them improve their cultural competence through learning about others.
  
• Learn to pronounce each student’s name correctly. Many people from other countries have names that may be more difficult for native English speakers to pronounce. Never assign a student a nickname or ask them to shorten their name or “make it easier” for you- This can negatively impact the student’s self worth and sense of belonging. Make a strong effort to learn the correct pronunciation and encourage others working with the student to do the same. Taking the time to learn correct pronunciation demonstrates to the student that you truly care about who they are as a person and shows a high level of respect.
  
• Host a cultural pot luck. In my time as a clinical nurse educator, I have been blessed to have worked with very diverse student populations. At the end of each semester, organizing a pot luck where each student brings a dish that is traditional to their culture makes for a fun and delicious celebration that also encourages conversation about the preferred foods, flavors, and agricultural products of other nations from around the world.

References

Chinn, P. L., & Falk-Rafael, A. (2018). Embracing the Focus of the Discipline of Nursing: Critical Caring Pedagogy. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 50(6), 687–984. Retrieved from http://dx.doi.org/10.1111/jnu.12426

Chinn, P. L., & Falk-Rafael, A. R. (2014). Peace and power: a theory of emancipatory group process. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 47(1), 62–69. https://doi.org/10.1111/jnu.12101

DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. BeaconPress. https://play.google.com/store/books/details/Robin_DiAngelo_White_Fragility?id=ZfQ3DwAAQBAJ

Oozageer Gunowa, N., Hutchinson, M., Brooke, J., Aveyard, H., & Jackson, D. (2021). Pressure injuries and skin tone diversity in undergraduate nurse education: qualitative perspectives from a mixed methods study. Journal of Advanced Nursing, 77(11), 4511-4524.

About Danielle “Dani” Brochu