HealthJuly 21, 2022

Changing how we teach culture to future nurses

By: Christie Cavallo, MSN, RN, EdDc, CNE, CNEcl
Culture is a concept that has been taught in every nursing curriculum for decades. Unfortunately, the content hasn’t changed much with the times.

But is there another way to make culture impactful to our students? As a nurse educator, teaching your students an understanding of cultural impact in medicine can make a measurable difference in patient care.

Confusing stereotypes with culture

In a typical nursing curriculum, you will find a definition of culture and then a list of definitions of race, ethnicity, religion, and so on. Students may learn a few theories of culture, and then talk about cultures, religions, and ethnicities be given facts about each one.

For example, most nursing students have been taught in nursing school about a religion that will not accept blood products, or that problems with high blood pressure are more prevalent among a particular race, or that certain cultures think it is disrespectful to look others in the eyes when talking. If you went to nursing school just mentioning one of these assumptions brings a group of people to your mind. Are we inadvertently sending students the wrong message? If this is all nursing educators teach about culture, what is really being taught is stereotyping.

Stereotyping is a generalized belief about a particular category of people that leads to an expectation that people might have about every person of a particular group.

The danger in stereotyping groups of people is that stereotyping leads to prejudice - an attitude toward a group of people because of beliefs. And prejudice leads to discrimination, which in the medical setting means denying someone a fundamental right to care because of the practitioner’s beliefs. As nurse educators we have an important role in stopping this kind of discrimination in medical treatment before it starts.

The impact of cultural education on medical practice

How might continuing to teach culture this way might affect a patient? Let’s consider an example. A new graduate nurse has a patient who is a member of a religion that does not eat meat according to what the nurse has learned in nursing school. The patient has a medical diagnosis of iron deficiency anemia. The nurse is performing discharge teaching on an iron-rich diet. But because the nurse believes the patient does not eat meat the nurse eliminates any teaching on iron-rich protein sources from animals. The patient does eat meat, but because the nurse assumed, the nurse avoided discussing those foods in their teaching.

Based on the instruction from the nurse, the patient believes meat is not a part of the prescribed diet and avoids it. See the potential for harm? This could have been avoided had the nurse received better cultural training during nursing school.

How to implement cultural diversity education in the nursing classroom

In my own teaching, I have adopted a new approach. Instead of teaching arbitrary facts about certain cultures, I taught the students sound facts about all cultures. All cultures have a power dynamic, beliefs about illness and cures, a present or future outlook, illness expressions, and taboo subjects. All patients need to be culturally assessed by the nurse for their own unique beliefs and values so that it can be considered as part of patient-centered care.

Most importantly, I taught the students to assess their own culture and how that affects them as future nurses. It is important to recognize and renounce their own biases about other cultures. This allows nursing students to address their biases before they affect their patients negatively.

Some ideas on how to practically implement this new way of teaching culture in nursing education are:

1. Ask the students to share in class

Students can share something they would want a nurse to know about their own cultural beliefs and practices if they were under their care. All the information I could have shared as a nursing instructor about different cultures cannot compare to how rich this open-ended question was in class. Students shared about their own beliefs, practices, diets, feelings about pain, eye contact, family dynamics, religions, etc. And it was just that, sharing, not rigid “truths” from a teacher about a certain group of people.

2. Assign the students to take a cultural assessment of a patient

As student nurses, they don’t need facts about groups of people, they need facts about the patient they are caring for. Each individual culture does have similarities, but each individual in that culture is very different. Getting to know a patient this way in school will forever stick in their mind to know their patient this way each time they care for a new one.

3. Talk about our own unconscious and implicit bias as educators

We see a person that is different from us and BOOM, unconscious and implicit thoughts come to our mind automatically. We choose to dismiss or entertain these thoughts about other people. It’s a common human problem. We have to do something uncommon about it - become aware and challenge those thoughts. Listen to our own language. Are we saying “They” a lot when we are having conversations? Who are “they” anyway?. The more we expose ourselves to others who are not like us, the better we will become at doing this. We are role modeling for our students the right way to view others.

4. Introduce differences within cultural groups

There is one difference they need to know about cultures and it’s called health disparities. Health disparities just simply mean not everyone has the same access to goods and services to lead a healthy life. Give statistics of the cultures that lack adequate housing, adequate maternal care, or have food insecurity. These statistics about the circumstances affecting certain groups of people disproportionally are important to share so our students can play a role in changing those statistics.

I’m so excited about how my own teaching about culture went this year! I hope you will get excited, too, as you see the value of changing your culture on teaching culture.

Explore solutions for nurse educators from Lippincott and help expose your students to diverse, real-world scenarios through Lippincott Clinical Experiences.

Learn More About Lippincott Nursing Education
Christie Cavallo, MSN, RN, EdDc, CNE, CNEcl
Expert Insights Contributor for Wolters Kluwer, Nursing Education
Lippincott® Nursing Education
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