Antidiscrimination pedagogical approaches to enhance diversity and inclusion in undergraduate nursing education: A critical analysis

Abstract

Background and objective: Nursing plays a vital role in promoting antidiscrimination pedagogical approaches within education. However, there remains a gap in developing inclusive teaching practices for ensuring culturally responsive nursing education. The objective of this study was to critically examine antidiscrimination pedagogical strategies designed to foster diversity and inclusion among undergraduate nursing students.

Methods: A critical interpretive qualitative study included a convenience sample of ninety-seven participants enrolled in an undergraduate nursing program at a Canadian university. A purposive sampling and an online survey were used for data collection. An antidiscrimination pedagogical strategy was used including pre-simulation, pre-briefing, simulation, debriefing, reflection and self-evaluation.

Results: Three themes emerged that focused on cultural and ethical understanding, active engagement and discussion, and gender and language illustration to understand the goals, strategies and impact of the case scenario.

Conclusions: This study demonstrates that implementing antidiscriminatory pedagogical strategies in nursing education yields benefits for fostering diversity and inclusion. Fostering an inclusive, culturally responsive, and equitable safe learning environment, enhances earning outcomes and promotes professional growth.

Implications: The implementation of anti-discrimination teaching pedagogy depends on nurse educators to integrate simulation-based education. Debriefing and reflection will ensure engaging students in diverse scenarios to apply responsive practices in nursing care.

Keywords

Antidiscrimination / Simulation / Debrief / Pedagogy / Nursing / Teaching / Learning / Inclusive / Diversity / Education

References

[1] D‘Souza MS, Arjunan P, Venkatesaperumal R. High fidelity simulation in nursing education. International Journal of Health Science Research. 2017; 7(7): 340-353.

[2] Hanshaw SL, Dickerson SS. High fidelity simulation evaluation studies in nursing education: A review of the literature. Nurse Education in Practice. 2020; 46: 102818. PMid:32623148 https://doi.org/10.1016/j.nepr.2020.102818

[3] El Hussein MT, Hirst SP. High-Fidelity Simulation’s impact on clinical reasoning and patient safety: a scoping review. Journal of Nursing Regulation. 2023; 13(4): 54-65. https://doi.org/10.1016/S2155-8256(23)00028-5

[4] D’Souza MS, Isac C, Venkatesaperumal R, et al. Exploring nursing student engagement in the learning environment for improved learning outcomes. Clinical Nursing Studies. 2014; 2(1): 1-16. https://doi.org/10.5430/cns.v2n1p1

[5] D’Souza MS, Nairy KS, Parahoo K. Venkatesaperumal R. 2015. Perception and Satisfaction of the Clinical Learning Environment among Nursing Students. Nurse Education Today. February 2015.

[6] Cooper Brathwaite A, Varsailles D, Haynes D. Building solidarity with Black nurses to dismantle systemic and structural racism in nursing. Policy, Politics, Nursing Practice. 2023; 24(1): 5-16. PMid:36300199 https://doi.org/10.1177/15271544221130052

[7] INACSL Standards Committee. INACSL standards of best practice: Simulation design. Clinical Simulation in Nursing. 2016; 12(S): S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005

[8] La Cerra C, Dante A, Caponnetto V, et al. Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: A systematic review and meta-analysis. BMJ Open. 2019; 9(2). PMid:30798316 https://doi.org/10.1136/bmjopen-2018-025306

[9] Government of Canada. Guide on equity, diversity and inclusion terminology. Interdepartmental Terminology Committee. 2024. Available from: https://www.noslangues-ourlanguages.gc.ca/en/publications/equite-diversite-inclusion-equity-diversity-inclusion-eng

[10] Moorley C, Darbyshire P, Serrant L, et al. Dismantling structural racism: Nursing must not be caught on the wrong side of history. Journal of Advanced Nursing. 2020; 76(10): 2450-2453. PMid:32692444 https://doi.org/10.1111/jan.14469

[11] Etowa J, Hyman I. Unpacking the health and social consequences of COVID-19 through a race, migration and gender lens. Canadian Journal of Public Health. 2021; 112(1): 8-11. PMid:33410121 https://doi.org/10.17269/s41997-020-00456-6

[12] Lopez AE, Jean-Marie G. Challenging anti-Black racism in everyday teaching, learning, and leading: From theory to practice. Journal of School Leadership. 2021; 31(1-2): 50-65. https://doi.org/10.1177/1052684621993115

[13] Kishimoto K. Anti-racist pedagogy: From faculty’s self-reflection to organizing within and beyond the classroom. Race Ethnicity and Education. 2018; 21(4): 540-554. https://doi.org/10.1080/13613324.2016.1248824

[14] Bell B. White dominance in nursing education: A target for antiracist efforts. Nursing Inquiry. 2021; 28(1): e12379. PMid:32881135 https://doi.org/10.1111/nin.12379

[15] Hustad J, Johannesen B, Fossum M, et al. Nursing students’ transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study. BMC Nursing. 2019; 18(1): 1-8. PMid:31719793 https://doi.org/10.1186/s12912-019-0376-5

[16] Park JE, Kim JH. Nursing students’ Psychological Safety in High fidelity Simulations: Development of a new scale for psychometric evaluation. Nurse Education Today. 2021; 105: 105017. PMid:34174511 https://doi.org/10.1016/j.nedt.2021.105017

[17] Guerrero JG, Hafiz AH, Eltohamy NAE, et al. Repeated exposure to high-fidelity simulation and nursing interns’ clinical performance: impact on practice readiness. Clinical Simulation in Nursing. 2021; 60: 18-24. https://doi.org/10.1016/j.ecns.2021.06.011

[18] Svellingen AH, Forstrønen A, Assmus J, et al. Simulation-based education and the effect of multiple simulation sessions-A randomised controlled study. Nurse Education Today. 2021; 106: 105059. PMid:34329963 https://doi.org/10.1016/j.nedt.2021.105059

[19] Koschmann KS, Jeffers NK, Heidari O. “I can’t breathe”: A call for antiracist nursing practice. Nursing outlook. 2020; 68(5): 539.35. PMid:32811661 https://doi.org/10.1016/j.outlook.2020.07.004

[20] Blanchet Garneau A, Browne AJ, Varcoe C. Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing. Nursing Inquiry. 2018; 25(1): e12211. PMid:28685947 https://doi.org/10.1111/nin.12211

[21] Atthill S, Witmer D, Luctkar-Flude M, et al. Exploring the impact of a virtual asynchronous debriefing method after a virtual simulation game to support clinical decision-making. Clinical Simulation in Nursing. 2021; 50: 10-18. https://doi.org/10.1016/j.ecns.2020.06.008

[22] Kolb DA, Boyatzis RE, Mainemelis C. Experiential learning theory: Previous research and new directions. In Perspectives on thinking, learning, and cognitive styles. Routledge. 2014; 227-248. https://doi.org/10.4324/9781410605986-9

[23] Theobald KA, Tutticci N, Ramsbotham J, et al. Effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students: A systematic review. Nurse Education in Practice. 2021; 57: 103220. PMid:34781195 https://doi.org/10.1016/j.nepr.2021.103220

[24] Yang SY. Effectiveness of neonatal emergency nursing education through simulation training: Flipped learning based on Tanner’s Clinical Judgement Model. Nursing Open. 2021; 8(3): 1314-1324. PMid:33432731 https://doi.org/10.1002/nop2.748

[25] Iheduru-Anderson K, Shingles RR, Akanegbu C. Discourse of race and racism in nursing: An integrative review of literature. Public Health Nursing. 2021; 38(1): 115-130. PMid:33155328 https://doi.org/10.1111/phn.12828

[26] Zanchetta MS, Cognet M, Rahman R, et al. Blindness, deafness, silence, and invisibility shields racism in nursing education practice in multicultural hubs of immigration. Journal of Professional Nursing. 2021; 37(2): 467-476.32. PMid:33867106 https://doi.org/10.1016/j.profnurs.2020.06.012

[27] Chittick H, Manhire K, Roberts J. Supporting success for Maori undergraduate nursing students in Aotearoa/New Zealand. Kai Tiaki Nursing Research. 2019; 10(1): 15-21.

[28] Iheduru-Anderson KC, Foley JA. Prelicensure Nursing Students’ Reflections on Institutional Response to the 2020 COVID-19 Crisis. Global Qualitative Nursing Research. 2022; 9: 23333936221106793. PMid:35782106 https://doi.org/10.1177/23333936221106793

[29] Lawrence M, Mudunuri S, Koenig W, et al. The winter curriculum audit. Student Equity, Faculty Professional Development, The Curriculum Committee, Guided Pathways, and the Academic Senate. Long Beach City College. 2020. Available from: https://asccc.org/sites/default/files/Winter%20Curriculum%20Audit%20Workbook%202.0.pdf

[30] Thorne S. Interpretive description: Qualitative research for applied practice. Routledge. 2016. https://doi.org/10.4324/9780203409527.ch22

[31] D’Souza MS. Using a research coach to enhance evidence-based practice integration with undergraduate nursing students. Journal of Nursing Education and Practice. 2021; 11(12): 73-81. https://doi.org/10.5430/jnep.v11n12p73

[32] D’Souza MS, Venkatesaperumal R, Chavez FS, et al. Effectiveness of Simulation among Undergraduate Students in the Critical Care Nursing. Int Arch Nurs Health Care. 2017; 3(4): 084. https://doi.org/10.23937/2469-5823/1510084

[33] D’Souza MS, Labrague LJ, Karkada SN, et al. Testing a diabetes ketoacidosis simulation in critical care nursing: A randomized control trial. Clinical Epidemiology and Global Health. 2020. https://doi.org/10.1186/ISRCTN12640591

[34] Kelly MA, Balakrishnan A, Krishnasamy N. Cultural considerations in simulation based education. Asia Pac Sch. 2018; 3: 1-4. https://doi.org/10.29060/TAPS.2018-3-3/GP1070

[35] Chernikova O, Heitzmann N, Stadler M, et al. Simulation-based learning in higher education: A meta-analysis. Review of Educational Research. 2020; 90(4): 499-541. https://doi.org/10.3102/0034654320933544

[36] D’Souza MS, Nikku B, Field C. Interdisciplinary Teaching Practices: Reflections from a Teaching Triangle. Journal of Nursing Education and Practice. 2021; 11(5): 10-15. https://doi.org/10.5430/jnep.v11n5p10

[37] Shepherd SM, Willis-Esqueda C, Newton D, et al. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Services Research. 2019; 19(1): 1-11. PMid:30808355 https://doi.org/10.1186/s12913-019-3959-7

[38] Stubbe DE. Practicing cultural competence and cultural humility in the care of diverse patients. Focus. 2020; 18(1): 49-51. PMid:32047398 https://doi.org/10.1176/appi.focus.20190041

[39] Hassen N, Lofters A, Michael S, et al. Implementing anti-racism interventions in healthcare settings: a scoping review. International Journal of Environmental Research and Public Health. 2021; 18(6): 2993. PMid:33803942 https://doi.org/10.3390/ijerph18062993