My career in pre-licensure nursing education started in 1986. As a professor at Capital Community College in Hartford, Connecticut, I have taught and learned much in the last 20-plus years. I have had the privilege to teach students from the immediate Hartford and greater Hartford areas, Mexico, the Caribbean, and several countries in South America, Europe, Asia, and sub-Saharan Africa. During a recent data-gathering project as part of a teaching innovation, students at my college were asked to self-disclose on race/ethnicity, gender, and age. The Class of 2013 in nursing was 15% African American, 11.1% Hispanic, and 5.5% Asian. The students’ predominant (46%) age range was 25 to 34 years old, and 12.7% of the students were male. Reflections on this rich student sample resulted in my personal list of the following top 10 teaching lessons that I have learned.
1. Examine your words carefully, both verbally and in writing.
I re-examine the words that I use in class or the college laboratory for double meanings. Common words such as “stoop” or “duck” are examples. If words can have more than one meaning, then I need to check in with the students to ensure that my message is clear. This is important when writing test questions. Some years ago, a student challenged the use of the words “granola bar.” This student was from Africa and did not know the type of food termed “granola.” My assumption was invalid, and now it is described as a cereal bar in a subsequent nutrition question.
2. Students may come from cultures where English is not their first language.
Also, students’ pre-collegiate educational preparation may not have been in English. However, students still need literacy skills to meet current health care expectations. Written assignments can strengthen skills and identify the few students who might need assistance from the Academic Success Center related to literacy. Having students lead a post-conference is another educational technique that can strengthen verbal fluency. An excellent student from Columbia who had the ability to lead was reticent to contribute verbally. Exposing students to group speaking validates their knowledge and boosts confidence. During last year’s spring semester, I looked around the conference table as students from Columbia, Puerto Rico, Poland, and the United States supported and enriched the clinical experience for each other. Having students give verbal reports to other health care givers or give mock reports over the phone to each other helps boost their fluency and confidence.
3. Recognize the cultural background that each student brings with him or her.
A student from Chile shared that when someone in her community was hospitalized the expectation was all family, friends, and neighbors would visit. It helped me to acknowledge and share that multiple visitors in a hospitalized patient’s room may be viewed as respect—not an assault on privacy or expediency.
A student from China offered up her cultural upbringing concerning the use of hot or cold foods related to a specific condition. There are two things that I have taken from this. Firstly, the reinforcement of alternative therapies such as heat and cold may be used before the prevalent dash to a pharmacological intervention. Secondly, it is an opportunity to encourage nursing students to assess the patient’s use of cultural therapies to ameliorate or cure a condition.
4. Appreciating the cultural background influences the teacher and student interaction.
A student from the Philippines would not look me in the eye as I was giving her feedback on a nursing procedure on campus. What could be interpreted as lack of engagement and assertiveness was a demonstration of her respect for someone who was in an authority position. Her comments to me opened the door for more substantial communication and a discussion of communication expectations in her role in the US.
5. Because of the college’s diversity, a number of students are the first in their family to pursue a college education.
Last year, a student from Vietnam shared that she was the only one in her group of friends who started the pre-requisite courses and who subsequently earned an Associate Degree in Nursing. As her advisor, I congratulated her on this significant accomplishment. I reviewed her resume at her request and went over sample questions for a hiring interview. This student’s paper was presented as an exemplar work in the nursing pharmacology course.
It is important, however, not to make this generalization. I taught a student from Albania whose parents were both educators. She was fluent in Albanian, French, and Italian prior to coming to this country. She worked in a bakery and lived above it until she mastered English. It was important to this student that I was aware of her personal history. She completed the Associate Degree, has since earned a Baccalaureate of Science in Nursing, and has been a homeowner for the last few years.
Another student from Bosnia privately shared her experiences during the war and the compelling reasons for her relocation to America. I often forget to acknowledge how nursing education is an important part in the process of achieving a student’s dream. I have learned to appreciate this important part in the student’s journey.
6.The student population that mirrors the cultural diversity in the community is an asset.
The health care setting is enriched when there is less difference among the caregivers and the care recipients. The selection of clinical sites that reflect the diversity in the community is important. It reinforces the concepts of physical assessment findings consistent with ethnicity. It reinforces the embracing of humanity that will serve the students well in their careers. My clinical site at the Hospital of Central Connecticut at New Britain General Hospital has three predominant languages: English, Spanish, and Polish. Patient-teaching material is available in all three languages, and staff is often bilingual. Patient compliance with the treatment plan is promoted with these approaches. While the hospital subscribes to a telephone language line, the immediacy of material provides culturally competent care. The diversity at the clinical site provides a lived learning experience.
7. Increase the use of pictures and videos in your teaching to reflect the diversity in the community and the student population.
My colleagues and I review textbooks and media that include cultural considerations. The nursing laboratory on campus has mannequins that represent virtual patients of diverse race/ethnicity and across the lifespan. Audio in any language can be uploaded to the human patient simulator to support cultural competency. Some cultural topics are anticipated, such as teaching about the cultural differences related to the epidemiology of tuberculosis. Other cultural topics are not as obvious, such as examining evidence-based literature to look for diversity in the study sample. For example, when I teach about nursing care of a person with a burn injury, I include pictures of burn survivors with lighter and darker complexions. In completing an online module on medication reconciliation, I was mindful to include pictures of persons from many ethnicities.
8. Students are taught to be lifelong learners.
There is benefit in my position as a role model for students related to continuing education. I started as an AD graduate in the 1970s. Progressing from a BSN in the 1980s to a Master’s in the 1990s, I completed a Doctorate in Nursing Practice in 2013. I can empathize with students about the joys and challenges of working while continuing along the educational path. Since faculty members do not usually graduate with advanced degrees, students may benefit from hearing about our personal journey in the education process. However, I challenge students to shorten the timeline for meeting advanced educational goals. Providing dual enrollment in the AD and RN-to-BSN programs is one way to promote advanced education. A local university has invited students to sit in on Bachelor’s degree level classes. With support from my colleagues, I have learned to introduce advancing education early and often.
9. Faculty’s improvement in teaching results from formal education and outside experience.
Formal education classes address strategies for teaching with diversity in learning styles, age, and culture. Education conferences or seminars are another mechanism for self-improvement. However, I have learned differently from travel experiences. On a nursing delegation to South Africa, I observed care at a rural HIV/AIDS clinic at Groote Schuur Hospital, which was the site of the first heart transplant, and visited a sangoma, the local healer. On a stay at a cattle station in the Australian outback, I learned about rural primary health care. On a trip to Costa Rica, I learned that some Americans receive care there for lower cost and comparable quality. Certification as a Reiki Master Teacher has provided me with another option to offer comfort to patients.
10. Appreciate the teaching and learning experience with a diverse student population.
I have taught students with a wide range of educational preparation. The spectrum has ranged from students with a GED in lieu of a high school diploma to a professor of economics who pursued nursing to give back to the Latino community. All nursing educators who teach a diverse student body deserve to be celebrated. Various and multiple teaching strategies are utilized by educators who teach students between the ages of 19 to over 50 years; students who balance the demands of school, work, and family; and students who bring different backgrounds to their nursing education. I admit to times of frustration, but the multiple teaching strategies can produce significant learning for students and teachers. This last lesson occurs over time after the other lessons have been internalized.
These 10 items are not meant only as a summary of lessons learned but rather a vehicle to amplify the concepts and expand the list in the future. There are many opportunities for more lessons to be learned. Embracing new technologies such as virtual, online health settings is an area for growth. The use of creative assignments such as video production, Wiki sites, or social media are areas for further learning by educators. Systematic review of the curriculum for content, learning activities, and assessment methods will continue to ensure optimal outcomes are met for all students. As a teacher, I look forward to the new lessons I will learn from the students.
Leona Konieczny, DNP, MPH, RN-BC, is a professor at Capital Community College in Hartford, Connecticut.