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Examining the Impact of Critical Multicultural Education Training on the Multicultural Attitudes, Awareness, and Practices of Nurse Educators
Examining the Impact of Critical Multicultural Education Training on theMulticultural Attitudes, Awareness, and Practices of Nurse Educators Kenya V. Beard PII: DOI: Reference:
S8755-7223(16)30026-6 doi: 10.1016/j.profnurs.2016.05.007 YJPNU 987
To appear in:
Journal of Professional Nursing
Please cite this article as: Beard, K.V., Examining the Impact of Critical Multicultural Education Training on theMulticultural Attitudes, Awareness, and Practices of Nurse Educators, Journal of Professional Nursing (2016), doi: 10.1016/j.profnurs.2016.05.007
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ACCEPTED MANUSCRIPT Examining the Impact of Critical Multicultural Education
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Running head: EXAMINING THE IMPACT OF CRITICAL
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Examining the Impact of Critical Multicultural Education Training on the
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Multicultural Attitudes, Awareness, and Practices of Nurse Educators
Kenya V. Beard
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Jersey College, NJ
Teterboro, NJ 07608 1.631.278.3805
[email protected]
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546 US Route 46
Word Count 4,688 This research project was funded by the Josiah Macy Jr. Foundation Faculty Scholar’s Program
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Abstract
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Some nurse educators lack training in the educational methods that facilitate learning among
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underrepresented groups (URGs). Limited awareness of equitable pedagogical practices could threaten the academic achievement of URGs and hinder efforts to make the nursing profession
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more heterogeneous. Training in multicultural education could strengthen the capacity of
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educators to create culturally responsive learning environments. This quasi-experimental study examined the impact that training in critical multicultural education had on the multicultural
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attitudes, awareness and practices of 37 nurse educators. A pre-post-test design without a control group found that the training was an effective way to strengthen the multicultural awareness and
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attitudes of nurse educators, although there was little impact on the multicultural practices. The
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nation’s capacity to improve the quality of health care hinges upon educators who can create inclusive learning environments and graduate diverse nurses. The findings could inform policies
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seeking to promote diversity and inclusion in nursing education.
diversity
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Keywords: nurse educators, multicultural education, underrepresented groups, workforce
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Examining the Impact of Critical Multicultural Education Training on the Multicultural Attitudes, Awareness, and Practices of Nurse Educators
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More than two decades ago the Institute of Medicine’s (IOM) report, In the Nation’s
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Compelling Interest: Ensuring Diversity in the Health Care Workforce emphasized the need for greater racial and ethnic diversity in the clinical workforce (2004). The IOM emphasized that
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individuals from minority groups are more likely to work in underserved areas which could
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increase access to care. Furthermore, they could provide culturally competent care that promotes healthcare quality and better communication and treatment for patients from all backgrounds.
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In response to the need for greater diversity in the nursing workforce, numerous nursing and philanthropy organizations have called for institutions of higher education to strengthen the
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recruitment and graduation of underrepresented groups (URGs); African American/Black,
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Hispanic/Latino, and Native American Indian (American Association of Colleges of Nursing, 2015; U. S. Department of Health and Human Services, 2011; Institute of Medicine, 2011;
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National League for Nursing, 2016). The Institute of Medicine’s report, The Future of Nursing:
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Leading Change, Advancing Health (2011), underscored the need to transform nursing education and increase efforts to improve diversity in nursing. In addition, the American Association of Colleges of Nursing (2015) has made the recruitment of URGs a nursing priority. Critical recommendations that can assist the nursing education community in creating more diverse and inclusive environments have been developed by the National League for Nursing (2016). While numerous initiatives and resources have resulted in a slight increase in the percentage of URGs in nursing, these efforts have failed to close the gap between the representation of URGs in nursing and society. African Americans/Blacks, American Indians or Alaskan Natives, and Hispanics/Latinos make up more than one-third of the United States’
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population, (United States Census Bureau, 2015). However, they represent less than ten percent of the nursing workforce (Budden, Zhong, Moulton & Cimiotti, 2013). The barriers that stall
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efforts to achieve a greater racial and ethnic diversity in nursing are multifactorial and have
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given rise to several well documented strategies. However, despite concerted efforts to achieve a more racially and ethnically diverse nursing workforce, much more work is needed. Leininger
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(1994) posited that the nursing profession needed to use a multicultural lens to recognize and
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address the changes that were needed in and around nursing education. Review of the Literature
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The issues that undermine the successful retention and graduation of URGs are multifactorial. First, the National Advisory Council on Nurse Education and Practice (2000)
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pointed out that minority students are more likely to graduate from high schools where teachers
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are less credentialed or where the academic bar is lowered. This could explain why poor academic performance has been cited as a contributing factor that impedes the graduation rates
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of some URGs (Giddens, 2008; White & Fulton, 2015).
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Sensitive Issues Imbedded in Diversity Racism, the act of discriminating individuals based on their racial identification, has threatened the presence of URGs in nursing (Barbee and Gibson, 2001; Childs et al, 2004; Hassouneh-Phillips & Beckett, 2003). White & Fulton (2015) conducted an integrative review of the experiences of African American nursing students. Their analysis of 17 studies found that perceptions of isolation and discrimination were a common thread. Some African American students believed that faculty racism was less overt. The students perceived that faculty did not want to help them and the rules were more strictly applied to them. The feelings of
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discrimination were not unique to the participants’ encounters with faculty but included students and nurses as well.
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A deeper examination of race-related issues has revealed that some schools of nursing
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may not be able to meet the learning needs of some URGs (Beard, 2013; Coleman, 2008; Dapremont, 2011; Downey, 2007; Giddens, 2008). In addition, the academic support that URGs
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need is not always recognized and provided (Beard, 2014; White & Fulton, 2015). Instructional
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practices that are unresponsive to the needs of URGs could partially explain the disparities in academic performance and contribute to disproportionate attrition rates (Hawley & Nieto, 2010).
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The nurse educator plays a central role in the students’ academic progression. Therefore, educators should understand that race and ethnicity could influence their assumptions about how
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students learn and necessitate a greater awareness of teaching practices that promote equity in
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education (Hawley & Nieto, 2010). But what are the assumptions held by nurse educators that impact the success of URGs? In the early 1900’s Caucasian educators believed that African
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Americans were intellectually inferior (Hine, 1989). Some educators still perceive that learning
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is more difficult for some minority nursing students (Beard, 2013). Nursing students might interpret an educator’s perception of learning difficulties as discriminatory and to be based on skin color. Indeed, some students believe that educators perceive them as ignorant (Sedgwick, Oosterbroek, Ponomar, 2014; White & Fulton, 2015). Negative assumptions about the intellectual skills of URGs or their ability to learn could undermine their academic success (Banks et al. 2001). Educators should have an opportunity to examine their personal prejudices and assumptions since this might help them identify and eliminate stereotypical beliefs about a student’s ability to learn (Sedgwick, Oosterbroek, & Ponomar, 2014).
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Promoting Equity in Education All nursing students deserve an opportunity to achieve academic excellence. Educators
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should be prepared to deliver an equitable pedagogy that considers the learning needs of URGs.
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Banks et al. (2001) defines equity pedagogy as teaching strategies that facilitate the academic success of all students. Educators should use pedagogical practices such as cooperative learning,
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pair/share activities, open dialogues, intentional efforts to bridge the gap between what the
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learners know and need to understand, and a belief that all students have cognitive strengths since these strategies support educational equity. (Banks & Banks, 2013; Gay, G. 2002).
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However, Beard (2013) explored the perceptions of nurse educators regarding their role in educating minority students and found that not all educators were aware of the pedagogical
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practices that supported equity in education. She found that some nurse educators lacked training
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in the educational methods that facilitate learning among URGs. In another study, some educators did not believe their educational programs adequately prepared them to effectively
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teach racially and ethnically diverse learners (Beard, 2014). Educational equity is the policies
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and practices that support the academic excellence of all students and lead to a just multicultural school (Banks et al., 2001). Limited awareness of pedagogical practices that align with educational equity could threaten the academic achievement of URGs and hinder efforts to make the nursing profession more heterogeneous. Training in pedagogical practices could improve the educator’s ability to create learning environments that meet the needs of all students. Benner, Sutphen, Leonard, and Day (2009) suggested that schools place a greater emphasis on the teaching/pedagogy component of the nurse educator’s role in order to improve the academic performance of all learners. To help improve policy and practices related to diversity, the Multicultural Education Consensus Panel
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(Banks et al., 2001) stated that faculty development programs should help educators “uncover and identify their personal attitudes toward racial, ethnic, language and cultural groups…and
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acquire the knowledge and skills needed to develop and implement an equity pedagogy” (p. 6).
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Institutions should consider the effect that an educators’ belief and assumption has on the outcomes of students from URGs (Villarruel, Bigelow, & Alvarez, 2014). Such efforts might
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help strengthen the capacity of nurse educators to teach and graduate more URGs into nursing.
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Why Multicultural Education
Multicultural education (ME) is an educational reform project that has been used in
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teacher education programs to promote educational equity and improve the academic outcomes of all students (Coggins & Campbell, 2008; Smith, 1997; Zirkel, 2008). ME emphasizes the need
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for an equitable pedagogy, helps to strengthen the multicultural awareness of teacher educators
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and promotes the academic success for all students (Banks 2006; Banks & Banks, 2013; Nieto & Bode, 2011).
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The principles of ME could be used to promote academic excellence among URGs and
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strengthen their presence in nursing. However, there is a dearth of nursing research that examines the extent to which ME strengthens the preparedness of educators to create culturally responsive learning environments. Gay (2002) defines culturally responsive learning environments “as using the cultural characteristics, experiences, and perspectives of ethnically diverse students as conduits for teaching them more effectively” (p. 106). She asserts that the academic achievement of all students can be strengthened when learning is meaningful, interesting and situated within the student’s lived experience. A body of literature that explores the impact that ME training has on the institutions’ environment, nurse educator’ capacity to teach diverse learners and student outcomes is needed.
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The aim of this study was to examine the impact that critical multicultural education training (cMET) had on the following three constructs; 1) multicultural attitudes, 2) multicultural
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awareness, and 3) multicultural practices. The constructs were defined as follows; multicultural
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attitudes are the beliefs and assumptions that nurse educators hold towards teaching URGs, multicultural awareness reflects a deep understanding of factors that hinder and facilitate the
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academic success of URGs, and multicultural practices are those pedagogical strategies that are
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used to support educational equity and promote the academic success of URGs Two overarching questions were used to guide this study:
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1. Does cMET influence the multicultural attitudes and awareness of nurse educators? 2. Does cMET strengthen the educator’s likelihood to adopt multicultural practices?
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Findings could help determine whether multicultural education (ME) is a plausible approach to
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assisting educators in creating learning environments that support and sustain greater diversity in nursing.
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Implementing an ME reform project might strengthen the capacity of nurse educators to
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create learning environments that support the academic success of all students. However, adopting the tenets of ME could require changes in attitudes towards URGs and teaching practices. Ajzen’s (1991) “theory of planned behavior” states that an individual’s intention to perform a behavior is determined by his or her attitudes and beliefs and one’s beliefs are influenced by what is known and experienced. His theory provided the rationale for examining the multicultural attitudes of nurse educators along with their level of multicultural awareness when seeking to strengthen the adoption of culturally responsive teaching practices.
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Methods Design
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This quasi-experimental study used a pre-post-test design without a control group to
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examine whether cMET influenced the multicultural attitudes, awareness, and practices that promote diversity in nursing. During the latter part of the spring semester of 2013, nurse
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educators were recruited by email on a rolling basis and informed that submission of the survey
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implied consent. After submitting the online baseline survey, educators were automatically invited to attend one of two sessions titled Critical Multicultural Education and Teaching
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Strategies. The training session was offered twice; once in June and once in July of 2013. Following the cMET session, respondents were given a week to complete the post-test survey.
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The author along with Dr. Dorinda Carter-Allen, an expert on multicultural education
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(ME) for teachers, used Bank’s (2006) conceptual framework for ME to create a workshop for nurse educators. The workshop was grounded in the literature and approved by the Arizona
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Nurses’ Association for six hours of continuing education credit. Emphasis was placed on
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Banks’ five key dimensions of ME; content integration, knowledge construction, prejudice reduction, establishing an equity pedagogy, and an empowering school culture and social structure. The learning objectives for the workshop were as follows: 1. Define critical multicultural education 2. Discuss the significance of workforce diversity 3. Identify attitudes towards teaching culturally diverse students 4. Discuss strategies for integrating dimensions of ME into nursing education 5. Identify practices that promote learning for culturally diverse students 6. Summarize barriers to implementing ME strategies in nursing education
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7. Design pedagogical practices that reflect an understanding of critical multicultural education
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Multiple teaching strategies were used to enhance learning and included pair and share exercises,
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role modeling, reflective writing, small and whole group work/discussions, interactive discussions, flip charts, video clips, and reflective listening. Participants were asked to complete
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an evaluation summary of the workshop in addition to the post-workshop survey.
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Sample
After obtaining approval from the author’s Institutional Review Board, a convenience
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sample of nurse educators at an urban public university were recruited for this study. Invitations to participate in the study were distributed to nurse educators and adjunct faculty (N= 370) who
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taught in the undergraduate or graduate programs of a multi-site university. The university
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system has 11 senior colleges, seven community colleges and five graduate and professional school. For study inclusion, respondents had to teach nursing students. Two reminders were
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emailed to improve response rates. Although there was no direct monetary award for
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participating in the study, respondents who attended the METs did receive meals. One hundred respondents completed the pre-workshop survey. Thirty-seven respondents attended the METS and completed the post-workshop survey. The overall response rate was 27 percent. Data Analysis SPSS was used to analyze the data. A pre-post comparison of mean responses on the three different multicultural scales was conducted before participation in the cMET and after the session. Since each survey did not record respondent identifiers, it was not possible to directly link the pre- and post-responses. This resulted in the need to use an independent samples t test instead of the dependent samples version, despite the fact that the data represent repeated
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measures. This means that the tests presented are conservative, because the independent samples version of the t test has less power.
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Instrument
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For this study, an eight item demographic questionnaire and the Nurse Educator Multicultural Awareness and Practices Scale (MAPS) was created by the principle investigator
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and used along with an edited version of the Teacher Multicultural Attitude Survey (TMAS)
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(Ponterotto, Blancy, Greig & Rivera, 1998). Permission to use and edit the TMAS was obtained by Dr. Ponterotto. Content validity for the MAPS was established by soliciting three reviewers
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who had a background in the educational needs of URGs. The wording on some of the items of the TMAS was modified in order to make it relevant to nurse educators. The respondents were
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asked to complete the demographic questions in addition to the MAPS which consisted of 36
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items measuring 1) multicultural awareness, and 2) multicultural practices, and the TMAS which consisted of 10 items measuring 3) multicultural attitudes. Respondents answered the questions
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for each scale using a five-point Likert rating ranging from Strongly Disagree to Strongly Agree.
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Higher scores on the TMAS suggested a greater level of appreciation towards issues related to multicultural teaching. On the MAPS, higher scores on the multicultural awareness scale suggested that educators were more mindful of the multicultural factors that hinder or facilitate the academic success of URGs. Higher scores on the multicultural practices scale suggested a stronger tendency towards the adoption of multicultural teaching practices that considered the learning needs of URGs. Workshop The workshop began with a brief introduction to ME. This was followed by a discussion about the importance of diversity in nursing and the role of culturally responsive learning
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environments. Participants were then given an opportunity to reflect on their personal attitudes and assumptions toward teaching culturally diverse students. This was followed by an interactive
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mini-lecture on the dimensions of ME. Strategies that facilitated the implementation of an
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equitable pedagogy and culturally responsive teaching were shared. The evidence-based barriers to implementing ME were also discussed. Next, the participants were placed in small groups so
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they could collectively identify issues that might hinder their implementation of ME and discuss
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ways to overcome the potential barriers at their respective institutions. The workshop ended with the participants designing and sharing a syllabus that reflected their understanding of CME.
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Results
Table 1 provides frequencies for demographics in both the pre- and post-workshop
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samples. The modal age group in both samples was 46-68 (78% pre-workshop, 83.78% post-
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workshop). Females far outnumbered males at both points in time (92% pre-workshop, 97.3% post-workshop). The largest racial/ethnic group represented was African Americans, who made
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up 45% of the pre-workshop sample and 45.95% of the post-workshop sample. Caucasian
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educators comprised the next largest category (37% pre-workshop, 40.54% post-workshop). Asians, Hispanics, and other race categories combined represented less than 17% of both the preand post-workshop samples. 82% of the pre-workshop sample and 94.59% of the post-workshop sample spoke English as a first language. The majority of the participants reported that they had a master’s degree (65% percent of the pre-workshop sample and 64.86% of the post-workshop sample). The doctoral degree was the next most common degree. Table 2 summarizes the teaching backgrounds of the study respondents. A little over half (53%) of the pre-workshop sample and a little under half (48.65%) of the post-workshop sample had taught for less than 11 years. The remaining subjects were divided almost equally between
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having taught between 11 to 20 years and more than 20 years. The modal teaching environment was the undergraduate classroom (59% pre-workshop, 56.76% post-workshop) followed by
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undergraduate clinical (28% pre-workshop, 32.43% post-workshop). The remaining respondents
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taught at the graduate level, either in the classroom or a clinical setting. More than half of the respondents (56% pre-workshop and 54.05% post-workshop) had a degree in nursing education.
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The overwhelming majority of respondents reported that they taught Hispanic, African
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American, and other culturally diverse students (97% pre-workshop, 97.3% post-workshop). More than one-half of the participants (64% pre-workshop, 22% post-workshop) denied having
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attended a course on educating culturally diverse students. After reverse coding some of the MAPS and TMAS items, scores were determined by
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taking the average response across the constituent items. Summary statistics, along with
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reliabilities (Cronbach’s alpha) are displayed in Table 3. Using the common convention of .7 as an acceptable value for Cronbach’s alpha, two of the three scales provide reliable measures.
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Multicultural Attitudes
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The multicultural attitudes were measured using 10 items. It yielded an alpha of .7047 among the pre-workshop sample and .7588 among the post-workshop sample. Differences in means between the pre- and post- workshop measures for multicultural attitudes are evident. The average score measured prior to the workshop was 4.045 (SD = .453), which increased to a mean of 4.358 (SD = .448) following the workshop (Table 3). Figure 1 displays pre- and postworkshop means along with error bars representing 95% confidence intervals around the mean. In the case of the attitudes scales, the error bars are bounded away from each other. This suggests significant differences before and after participation, since the sampling variances do not overlap. The conservative independent samples t test (adjusting for unequal variance) confirms
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these results (Table 4) and reveal a significant difference on the attitudes scale (t = -3.54, df = 65, p < .001).
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Multicultural Awareness
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The multicultural awareness was measured using 25 items and produced a Cronbach’s alpha of .7545 among the pre-workshop observations and .7537 post-workshop. Table 3 shows
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differences in means between the pre- and post-workshop measures. The mean score on the
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awareness scale was 2.901 (SD = .321) prior to the workshop, which increased to 3.217 (SD = .313) after. Figure 2 displays pre and post-workshop means along with error bars representing
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95% confidence intervals around the mean. In the case of the awareness scale, the error bars are also bounded away from each other, suggesting significant differences before and after
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participation. The conservative independent samples t test (adjusting for unequal variance)
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confirms these results as well (Table 4). Means are significantly different on the awareness scale (t = -5.09, df = 66, p < .001).
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Multicultural Practices
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The multicultural practices were measured with 11 items, had lower reliability scores. Prior to the workshop, the items produced an alpha value of .684. Post-workshop, the value was .5589. A follow-up analysis considered whether dropping any item would lead to an increase in reliability. There were, however, no questions that clearly weighed down the value of Cronbach’s alpha, so none were deleted. Given the relatively low alpha, the practices scale likely consists of more noise than the other two scales, meaning it may be more difficult to find a significant result for this particular item. The distinction for significant differences before and after participation are not clear for the practices scale. The multicultural practices scale (Table 3), had a pre-workshop mean of
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3.285 (SD = .438) and a post-workshop mean of 3.432 (SD = .407). Although the post-workshop mean is higher, it has a large 95% confidence interval that overlaps with the sampling variance
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of the pre-workshop mean, thus suggesting it is not possible to statistically distinguish between
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the two groups (Figure 3). In addition, the conservative independent samples t test (adjusting for
significantly different (t = -1.79, df = 69, p = .077).
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Discussion
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unequal variance), revealed that the differences for the practices scale (Table 4) were not
The nation’s capacity to improve the quality of health care hinges upon educators who
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can create inclusive learning environments and graduate diverse nurses. Nurse educators play an instrumental role in the academic progression of students and are essential stakeholders in the
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initiatives that seek to eliminate racial and ethnic academic achievement gaps. Diversity
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initiatives could trigger conflicts between self and public interest (Stone, 2011). Therefore, it is imperative that administrators create safe environments that allow nurse educators to explore
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their attitudes, beliefs and practices.
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This study took place at an institution where the majority of faculty were Caucasian. However, the participants did not reflect that demographic. The session was predominantly represented by African American/Black educators. Why educators who attended the cMET session did not reflect the race and ethnic makeup of the total faculty population is a cause for concern and deserves further exploration. Some studies have revealed that African American/Black faculty are more likely to enter academia to serve as role models for URGs and support their academic success (Zajac, 2011). The African American educators’ internal commitment to support the success of URGs might explain why the sessions were widely attended by minority educators. The limited participation and presence of Caucasian faculty
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members might have stemmed from their belief that their instructional practices were already culturally responsive. In addition, race-related issues are oftentimes viewed as sensitive in
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nature. Some educators may not have attended because of the nature of the workshop. The
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workshops were conducted over the summer which could have also precluded the presence of many educators. Nevertheless, 40% of participants who attended the workshop were Caucasian.
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An overwhelming majority of participants taught URGs and the master’s degree was the
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highest earned degree for the majority of participants. A little over one-third of the participants (36%) attended a course on educating culturally diverse students. Both junior and senior
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educators attended the workshop which suggests that multicultural learning needs exist across the various age groups and regardless of the years of teaching experience.
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This study examined the impact that cMET had on the multicultural attitudes, awareness
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and practices of nurse educators. The findings revealed that the nurse educators’ awareness of factors that hinder or facilitate the academic success of URG’s were limited and attending the
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cMET strengthened their multicultural awareness. The respondents had high levels of
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appreciation towards multicultural teaching prior to the workshop. The cMET also strengthened their multicultural attitudes which could foster the adoption of practices that ensure educational equity. Positive assumptions about URGs is critical since negative beliefs could adversely affect student outcomes (Banks, 2006; Nieto & Bode, 2011; Chu, 2011). Further studies should seek to examine what correlations, if any, exist between cMET and the retention and graduation of URGs. The use of cMET did not significantly influence the practices that nurse educators use to teach culturally diverse students. Part of the reason for the non-significance in the practices scale may be due to its relatively low reliability, as shown in Table 2. It may nonetheless have turned
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out to be significant had it been possible to match the pre and post-workshop respondents so that the more powerful dependent samples t test could have been carried out. Plugging the sample
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estimates for the variance and standard deviations into the formula for standard error, it is
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possible to determine what the size of r must have been before the result would have been significant. Doing so showed that, if r had turned out to be .21 or higher, the test would have
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been significant. In other words, only a moderate correlation between the pre and post scores
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would have produced a significant dependent samples t test. This is a realistic possibility, albeit one that cannot be tested with the current data. A future study that retains identifiers to match pre
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and post scores will thus likely find significant changes, especially if the post-sample is larger. Educators play a critical role in helping institutions move the needle towards greater
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diversity in nursing. Thus, institutions must confirm that educators are aware of pedagogical
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practices that promote equity in the classroom and prepared to support a socially just curriculum (Nieto & Bode, 2011; Banks & Banks, 2013). Educators must also possess the capacity to meet
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the learning needs of URGs. Institutions should develop evaluation metrics that consider the
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educators proficiency in creating learning environments that promote educational equity. Administrators should provide funding for and access to training programs that strengthen the educators’ role in teaching diverse populations. The United States is rapidly becoming more ethnically and racially diverse. This heightens the need to ensure that nurse educators are cognizant of the factors that promote the academic success of URGs and possess the skillsets to teach them. The goal of achieving greater diversity in nursing may continue to extend beyond the professions’ reach unless reform efforts consider the multicultural attitudes, awareness and practices of educators.
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Limitations Several limitations of this study are acknowledged. First, caution should be taken when
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interpreting the data since factors outside the intervention could have influenced the findings.
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This study did not allow for measurement of the multicultural constructs over time and only looked at short-term influences. Secondly, this study did not distinguish between faculty and
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adjunct faculty. These groups could have different educational preparations and experiences
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which could have influenced outcomes. Thirdly, findings from this intervention were based on a small sample that was not randomly selected. The limited number of participants makes it
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difficult to generalize the findings. Future studies should include a larger sample that allows for stratified sampling. In addition, a longitudinal design should be used to reveal whether the
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multicultural changes persist over time. Lastly, the scale that was used to identify multicultural
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practices had a low reliability making it difficult to draw conclusions from it. The reliability of
Conclusions
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the scale could improve with a larger sample.
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In closing, diversity is crucial to assuaging health care disparities (U.S. Department of Health and Human Services, 2011). Training in ME is a plausible way to strengthen the nurse educators’ appreciation towards multicultural teaching and awareness of factors that hinder or facilitate the academic success of URGs. When educators have positive attitudes towards URGs and are knowledgeable about the learning needs of URGs, they have the power to translate that knowledge into effective instructional practices and create learning environments that support the academic success of all students (National Education Association, 2008; Ume-Nwagbo, 2012). Failing to adopt multicultural practices that address the learning needs of all students could disproportionately affect the academic success of URGs and undermine efforts to improve
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workforce diversity. Although the scale that was used to measure the construct of multicultural practices had a low reliability, nurse educators should examine the extent to which they use the
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pedagogical practices that promote educational equity.
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This cMET program has great implications for nursing science. Potential findings extend far beyond the academic success of URGs and embody the essence of Health Care Reform; to
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promote health equity by meeting the health care needs of all members. The use of cMET should
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strengthen the capacity of nursing programs to meet the learning needs of all students and graduate culturally diverse students who are prepared to care for underserved populations.
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Findings from this study should help to broaden the teaching capacity of educators and inform policies that seek to promote diversity and inclusion in nursing education. Improving the learning
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environment of all students should lead to the graduation of a diverse workforce that’s prepared
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to deliver high quality care and eliminate health care disparities.
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American Association of Colleges of Nursing. (2015). Enhancing diversity in the workforce. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/enhancing-
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Banks, J. A. (2006). Cultural diversity and education: Foundations, curriculum and teaching
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(5th ed.). Boston: Pearson Education.
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Banks, J. A., & Banks, C. A. (2013). Multicultural education. (8th ed.) Boston: John Wiley & Sons.
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Banks, J. A., Cookson, P., Gay, G., Hawley, W. D., Irvine, J. J., Nieto, S., Schofield, J. W., &
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Stephan, W. G. (2001). Diversity within unity: Essential principles for teaching and learning in a multicultural society. Retrieved from http://education.washington.edu/cme/DiversityUnity.pdf Barbee, E., & Gibson, B. (2001). Our dismal progress: The recruitment of non-whites into nursing. Journal of Nursing Education, 40(6), 243-244. Beard, K. (2013). Teaching in a multicultural society: how nurse educators describe their role. Journal of the National Black Nurses Association. 24(2):64-71. Beard, K. V. (2014). Strengthening diversity in nursing: The practices and preparedness of nursing faculty. Journal of Nursing Education and Practice. 4(11), 59-65.
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Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass.
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Budden, J. S., Zhong, E. H., Moulton, P. & Cimiotti, J. P. (2013). Highlights of the national
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workforce survey of registered nurses. Journal of Nursing Regulation, 4(2), 5-14. Bureau of Health Professions. (2010). The registered nurse population: Findings from the 2008
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national sample survey of registered nurses. Retrieved from
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http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf. Childs, G., Jones, R., Nugent, K., & Cook, P. (2004). Retention of African-American students in
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baccalaureate nursing programs: Are we doing enough? Journal of Professional Nursing, 20(2), 129-133.
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Chu, S. Y. (2011). Understanding the schooling and achievement of culturally and linguistically
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diverse backgrounds. Journal of Instructional Psychology, 38(3), 201-209. Coggins P., & Campbell, S. (2008). Using cultural competence to close the achievement gap.
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Journal of Pan African Studies, 2(4), 44-58.
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Coleman, L. D. (2008). Experiences of African American students in a predominantly white, two-year nursing program. The Association of Black Nursing Faculty Journal, 19(1), 813.
Dapremont, J. A. (2011). Success in nursing school: Black nursing students’ perception of peers, family, and faculty. Journal of nursing education, 50(5), 254-260. Downey, J., & Cobbs, G. (2007). “I actually learned a lot from this”: A field assignment to prepare future preservice math teachers for culturally diverse classrooms. School Science and Mathematics, 107(1), 391-403.
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Gay, G. (2002). Preparing for culturally responsive teaching. Journal of Teacher Education, 53(2), 106-116.
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Giddens, J. (2008). Achieving diversity in nursing through multicontextual learning
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Hassouneh-Phillips, D., & Beckett, A. (2003). An education in racism. Journal of Nursing
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Education, 42(6), 258-265.
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Hawley, W. D. & Nieto, S. (2010). Another inconvenient truth: Race and Ethnicity. Educational Leadership, 63(3), 66-71.
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U. S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities: A nation free of health disparities. Retrieved from
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Hine, D. C. (1989). Black women in white: Racial conflict and cooperation in the nursing profession 1890-1950. Bloomington: Indiana University Press.
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Institute of Medicine. (2004). In the nation’s compelling interest: Ensuring diversity in the
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health-care workforce. Washington D.C.: National Academies Press. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington D.C.: National Academies Press. Leininger, M. (1994). Transcultural nursing education: A worldwide imperative. Nursing and Health Care, 15(5), 254-257. National Advisory Council on Nurse Education and Practice. (2000). A national agenda for nursing workforce racial/ethnic diversity. Retrieved from http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/firstreport.pdf. A
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National Education Association. (2008). Promoting educators’ cultural competence to better serve culturally diverse students. Retrieved from
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www.nea.org/assets/docs/PB13_CulturalCompetence08.pdf
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National League for Nursing. (2016). Diversity in Nursing: An NLN Vision Statement. Retrieved from http://www.nln.org/newsroom/news-releases/news-release/2016/02/16/diversity-in-
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nursing-an-nln-vision-statement
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Nieto, S. & Bode, P. (2011). Affirming diversity: The sociopolitical context of multicultural education (6th ed.). Boston: Allyn and Bacon.
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Ponterotto, J., Baluch, S., Greig, T., & Rivera, L. (1998). Development and initial score validation of the teacher multicultural attitude survey. Educational and Psychological
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Measurement, 58(6), 1002-1016.
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Sedgwick, M. Oosterbroek, T. & Ponomar, V. (2014). “It all depends”: How minority nursing students experience belonging during clinical experiences, Nursing Education
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Perspectives, 35(2), 89-93.
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Smith, D. G., et. al. (1997). Diversity Works: The Emerging Picture of How Students Benefit. Washington, D.C.: Association of American Colleges and Universities. Stone, D. (2011). Policy paradox: The art of political decision making (3rd Ed.). W. W. Norton. Ume-Nwagbo, P. N. (2013). Implications of nursing faculties’ cultural competence. Journal of Nursing Education, 51(5):262-268. U.S. Census Bureau. (2015). State & county quick facts. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html Villarruel, A. M., Bigelow, A., & Alvarez, C. (2014). Integrating the 3Ds: A nursing perspective. Public Health Reports, 2(129), 36-44.
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White, B. & Fulton, J. S. (2015). The common experiences of African American nursing students: An integrative review. Nursing Education Perspectives, 36(3), 167-175.
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Zajac, L. (2011). Double-loop approach: Recruitment and retention for minority nursing
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faculty. ABNF Journal, 22(3), 73-77.
Zirkel, S. (2008). The influence of multicultural educational practices on student outcomes and
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intergroup relations. Teachers College Record, 110(6), 1147-1181.
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Table 1 Sample Demographics
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Age 30 or under 1 31-47 13 48-68 78 69 or over 8 Gender Male 8 Female 92 Race/Ethnicity Other (please specify 3 Asian 7 Black or African American 45 Hispanic/Latino 6 Native Hawaiian or Pacific Islander 1 White 38 English First Language Yes 82 No 18 Degree Baccalaureate 5 Master's 65 Doctorate 30 Note. Pre-Workshop N = 100, Post-Workshop N = 37
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Pre-Workshop N Percent
Post-Workshop N Percent
1 13 78 8
0 4 31 2
0 10.81 83.78 5.41
8 92
1 36
2.7 97.3
3 7 45 6 1 38
2 0 17 3 0 15
5.41 0 45.95 8.11 0 40.54
82 18
35 2
94.59 5.41
5 65 30
1 24 12
2.7 64.86 32.43
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Table 2 Teaching Background
18 11 8
48.65 29.73 21.62
59 28 10 3
21 12 3 1
56.76 32.43 8.11 2.7
56 44
20 17
54.05 45.95
97 3
36 1
97.3 2.7
36 64
15 22
40.54 59.46
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53 24 23
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Years Teaching in Academic Setting Less than 11 years 53 11-20 Years 24 More than 20 Years 23 Primary Level Taught Undergraduate classroom 59 Undergraduate clinical 28 Graduate classroom 10 Graduate clinical 3 Degree in Nursing Education? Yes 56 No 44 Currently Teach African American, Hispanics, etc.? Yes 97 No 3 Courses on Educating Culturally Diverse Students? Yes 36 No 64 Note. Pre-Workshop N = 100, Post-Workshop N = 37
Post-Workshop N Percent
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Pre-Workshop N Percent
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Table 3 Scale Summary Statistics
Pre-Workshop SD 0.453 0.321 0.438
Alpha 0.7047 0.7545 0.684
Table 4 Difference in Means Test for Pre versus Post Workshop Scales Mean SE Scale Difference Difference t Multicultural Attitudes -0.313 0.088 -3.54 Multicultural Awareness -0.316 0.062 -5.09 Multicultural Practices -0.147 0.082 -1.79
df 65 66 69
Scale Multicultural Attitudes Multicultural Awareness Multicultural Practices
# Items 10 25 11
Mean 4.045 2.901 3.285
Post-Workshop Mean SD Alpha 4.358 0.448 0.7588 3.217 0.313 0.7537 3.432 0.407 0.5589
p <.001 <.001 0.077
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Highlights for Examining the Impact of CMET
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Racial and ethnic diversity in the clinical workforce is critical to improving the quality of healthcare A deeper examination of race-related issues have revealed that some schools of nursing may not be able to meet the learning needs of some underrepresented groups Multicultural education (ME) is an educational reform project that has been used in teacher education programs to promote educational equity and improve the academic outcomes of all students
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S8755-7223(16)30026-6 doi: 10.1016/j.profnurs.2016.05.007 YJPNU 987
To appear in:
Journal of Professional Nursing
Please cite this article as: Beard, K.V., Examining the Impact of Critical Multicultural Education Training on theMulticultural Attitudes, Awareness, and Practices of Nurse Educators, Journal of Professional Nursing (2016), doi: 10.1016/j.profnurs.2016.05.007
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Running head: EXAMINING THE IMPACT OF CRITICAL
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Examining the Impact of Critical Multicultural Education Training on the
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Multicultural Attitudes, Awareness, and Practices of Nurse Educators
Kenya V. Beard
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Jersey College, NJ
Teterboro, NJ 07608 1.631.278.3805
[email protected]
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546 US Route 46
Word Count 4,688 This research project was funded by the Josiah Macy Jr. Foundation Faculty Scholar’s Program
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Abstract
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Some nurse educators lack training in the educational methods that facilitate learning among
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underrepresented groups (URGs). Limited awareness of equitable pedagogical practices could threaten the academic achievement of URGs and hinder efforts to make the nursing profession
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more heterogeneous. Training in multicultural education could strengthen the capacity of
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educators to create culturally responsive learning environments. This quasi-experimental study examined the impact that training in critical multicultural education had on the multicultural
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attitudes, awareness and practices of 37 nurse educators. A pre-post-test design without a control group found that the training was an effective way to strengthen the multicultural awareness and
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attitudes of nurse educators, although there was little impact on the multicultural practices. The
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nation’s capacity to improve the quality of health care hinges upon educators who can create inclusive learning environments and graduate diverse nurses. The findings could inform policies
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seeking to promote diversity and inclusion in nursing education.
diversity
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Keywords: nurse educators, multicultural education, underrepresented groups, workforce
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Examining the Impact of Critical Multicultural Education Training on the Multicultural Attitudes, Awareness, and Practices of Nurse Educators
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More than two decades ago the Institute of Medicine’s (IOM) report, In the Nation’s
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Compelling Interest: Ensuring Diversity in the Health Care Workforce emphasized the need for greater racial and ethnic diversity in the clinical workforce (2004). The IOM emphasized that
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individuals from minority groups are more likely to work in underserved areas which could
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increase access to care. Furthermore, they could provide culturally competent care that promotes healthcare quality and better communication and treatment for patients from all backgrounds.
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In response to the need for greater diversity in the nursing workforce, numerous nursing and philanthropy organizations have called for institutions of higher education to strengthen the
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recruitment and graduation of underrepresented groups (URGs); African American/Black,
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Hispanic/Latino, and Native American Indian (American Association of Colleges of Nursing, 2015; U. S. Department of Health and Human Services, 2011; Institute of Medicine, 2011;
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National League for Nursing, 2016). The Institute of Medicine’s report, The Future of Nursing:
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Leading Change, Advancing Health (2011), underscored the need to transform nursing education and increase efforts to improve diversity in nursing. In addition, the American Association of Colleges of Nursing (2015) has made the recruitment of URGs a nursing priority. Critical recommendations that can assist the nursing education community in creating more diverse and inclusive environments have been developed by the National League for Nursing (2016). While numerous initiatives and resources have resulted in a slight increase in the percentage of URGs in nursing, these efforts have failed to close the gap between the representation of URGs in nursing and society. African Americans/Blacks, American Indians or Alaskan Natives, and Hispanics/Latinos make up more than one-third of the United States’
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population, (United States Census Bureau, 2015). However, they represent less than ten percent of the nursing workforce (Budden, Zhong, Moulton & Cimiotti, 2013). The barriers that stall
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efforts to achieve a greater racial and ethnic diversity in nursing are multifactorial and have
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given rise to several well documented strategies. However, despite concerted efforts to achieve a more racially and ethnically diverse nursing workforce, much more work is needed. Leininger
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(1994) posited that the nursing profession needed to use a multicultural lens to recognize and
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address the changes that were needed in and around nursing education. Review of the Literature
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The issues that undermine the successful retention and graduation of URGs are multifactorial. First, the National Advisory Council on Nurse Education and Practice (2000)
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pointed out that minority students are more likely to graduate from high schools where teachers
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are less credentialed or where the academic bar is lowered. This could explain why poor academic performance has been cited as a contributing factor that impedes the graduation rates
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of some URGs (Giddens, 2008; White & Fulton, 2015).
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Sensitive Issues Imbedded in Diversity Racism, the act of discriminating individuals based on their racial identification, has threatened the presence of URGs in nursing (Barbee and Gibson, 2001; Childs et al, 2004; Hassouneh-Phillips & Beckett, 2003). White & Fulton (2015) conducted an integrative review of the experiences of African American nursing students. Their analysis of 17 studies found that perceptions of isolation and discrimination were a common thread. Some African American students believed that faculty racism was less overt. The students perceived that faculty did not want to help them and the rules were more strictly applied to them. The feelings of
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discrimination were not unique to the participants’ encounters with faculty but included students and nurses as well.
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A deeper examination of race-related issues has revealed that some schools of nursing
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may not be able to meet the learning needs of some URGs (Beard, 2013; Coleman, 2008; Dapremont, 2011; Downey, 2007; Giddens, 2008). In addition, the academic support that URGs
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need is not always recognized and provided (Beard, 2014; White & Fulton, 2015). Instructional
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practices that are unresponsive to the needs of URGs could partially explain the disparities in academic performance and contribute to disproportionate attrition rates (Hawley & Nieto, 2010).
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The nurse educator plays a central role in the students’ academic progression. Therefore, educators should understand that race and ethnicity could influence their assumptions about how
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students learn and necessitate a greater awareness of teaching practices that promote equity in
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education (Hawley & Nieto, 2010). But what are the assumptions held by nurse educators that impact the success of URGs? In the early 1900’s Caucasian educators believed that African
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Americans were intellectually inferior (Hine, 1989). Some educators still perceive that learning
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is more difficult for some minority nursing students (Beard, 2013). Nursing students might interpret an educator’s perception of learning difficulties as discriminatory and to be based on skin color. Indeed, some students believe that educators perceive them as ignorant (Sedgwick, Oosterbroek, Ponomar, 2014; White & Fulton, 2015). Negative assumptions about the intellectual skills of URGs or their ability to learn could undermine their academic success (Banks et al. 2001). Educators should have an opportunity to examine their personal prejudices and assumptions since this might help them identify and eliminate stereotypical beliefs about a student’s ability to learn (Sedgwick, Oosterbroek, & Ponomar, 2014).
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Promoting Equity in Education All nursing students deserve an opportunity to achieve academic excellence. Educators
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should be prepared to deliver an equitable pedagogy that considers the learning needs of URGs.
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Banks et al. (2001) defines equity pedagogy as teaching strategies that facilitate the academic success of all students. Educators should use pedagogical practices such as cooperative learning,
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pair/share activities, open dialogues, intentional efforts to bridge the gap between what the
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learners know and need to understand, and a belief that all students have cognitive strengths since these strategies support educational equity. (Banks & Banks, 2013; Gay, G. 2002).
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However, Beard (2013) explored the perceptions of nurse educators regarding their role in educating minority students and found that not all educators were aware of the pedagogical
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practices that supported equity in education. She found that some nurse educators lacked training
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in the educational methods that facilitate learning among URGs. In another study, some educators did not believe their educational programs adequately prepared them to effectively
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teach racially and ethnically diverse learners (Beard, 2014). Educational equity is the policies
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and practices that support the academic excellence of all students and lead to a just multicultural school (Banks et al., 2001). Limited awareness of pedagogical practices that align with educational equity could threaten the academic achievement of URGs and hinder efforts to make the nursing profession more heterogeneous. Training in pedagogical practices could improve the educator’s ability to create learning environments that meet the needs of all students. Benner, Sutphen, Leonard, and Day (2009) suggested that schools place a greater emphasis on the teaching/pedagogy component of the nurse educator’s role in order to improve the academic performance of all learners. To help improve policy and practices related to diversity, the Multicultural Education Consensus Panel
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(Banks et al., 2001) stated that faculty development programs should help educators “uncover and identify their personal attitudes toward racial, ethnic, language and cultural groups…and
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acquire the knowledge and skills needed to develop and implement an equity pedagogy” (p. 6).
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Institutions should consider the effect that an educators’ belief and assumption has on the outcomes of students from URGs (Villarruel, Bigelow, & Alvarez, 2014). Such efforts might
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help strengthen the capacity of nurse educators to teach and graduate more URGs into nursing.
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Why Multicultural Education
Multicultural education (ME) is an educational reform project that has been used in
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teacher education programs to promote educational equity and improve the academic outcomes of all students (Coggins & Campbell, 2008; Smith, 1997; Zirkel, 2008). ME emphasizes the need
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for an equitable pedagogy, helps to strengthen the multicultural awareness of teacher educators
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and promotes the academic success for all students (Banks 2006; Banks & Banks, 2013; Nieto & Bode, 2011).
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The principles of ME could be used to promote academic excellence among URGs and
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strengthen their presence in nursing. However, there is a dearth of nursing research that examines the extent to which ME strengthens the preparedness of educators to create culturally responsive learning environments. Gay (2002) defines culturally responsive learning environments “as using the cultural characteristics, experiences, and perspectives of ethnically diverse students as conduits for teaching them more effectively” (p. 106). She asserts that the academic achievement of all students can be strengthened when learning is meaningful, interesting and situated within the student’s lived experience. A body of literature that explores the impact that ME training has on the institutions’ environment, nurse educator’ capacity to teach diverse learners and student outcomes is needed.
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The aim of this study was to examine the impact that critical multicultural education training (cMET) had on the following three constructs; 1) multicultural attitudes, 2) multicultural
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awareness, and 3) multicultural practices. The constructs were defined as follows; multicultural
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attitudes are the beliefs and assumptions that nurse educators hold towards teaching URGs, multicultural awareness reflects a deep understanding of factors that hinder and facilitate the
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academic success of URGs, and multicultural practices are those pedagogical strategies that are
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used to support educational equity and promote the academic success of URGs Two overarching questions were used to guide this study:
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1. Does cMET influence the multicultural attitudes and awareness of nurse educators? 2. Does cMET strengthen the educator’s likelihood to adopt multicultural practices?
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Findings could help determine whether multicultural education (ME) is a plausible approach to
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assisting educators in creating learning environments that support and sustain greater diversity in nursing.
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Implementing an ME reform project might strengthen the capacity of nurse educators to
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create learning environments that support the academic success of all students. However, adopting the tenets of ME could require changes in attitudes towards URGs and teaching practices. Ajzen’s (1991) “theory of planned behavior” states that an individual’s intention to perform a behavior is determined by his or her attitudes and beliefs and one’s beliefs are influenced by what is known and experienced. His theory provided the rationale for examining the multicultural attitudes of nurse educators along with their level of multicultural awareness when seeking to strengthen the adoption of culturally responsive teaching practices.
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Methods Design
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This quasi-experimental study used a pre-post-test design without a control group to
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examine whether cMET influenced the multicultural attitudes, awareness, and practices that promote diversity in nursing. During the latter part of the spring semester of 2013, nurse
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educators were recruited by email on a rolling basis and informed that submission of the survey
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implied consent. After submitting the online baseline survey, educators were automatically invited to attend one of two sessions titled Critical Multicultural Education and Teaching
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Strategies. The training session was offered twice; once in June and once in July of 2013. Following the cMET session, respondents were given a week to complete the post-test survey.
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The author along with Dr. Dorinda Carter-Allen, an expert on multicultural education
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(ME) for teachers, used Bank’s (2006) conceptual framework for ME to create a workshop for nurse educators. The workshop was grounded in the literature and approved by the Arizona
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Nurses’ Association for six hours of continuing education credit. Emphasis was placed on
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Banks’ five key dimensions of ME; content integration, knowledge construction, prejudice reduction, establishing an equity pedagogy, and an empowering school culture and social structure. The learning objectives for the workshop were as follows: 1. Define critical multicultural education 2. Discuss the significance of workforce diversity 3. Identify attitudes towards teaching culturally diverse students 4. Discuss strategies for integrating dimensions of ME into nursing education 5. Identify practices that promote learning for culturally diverse students 6. Summarize barriers to implementing ME strategies in nursing education
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7. Design pedagogical practices that reflect an understanding of critical multicultural education
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Multiple teaching strategies were used to enhance learning and included pair and share exercises,
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role modeling, reflective writing, small and whole group work/discussions, interactive discussions, flip charts, video clips, and reflective listening. Participants were asked to complete
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an evaluation summary of the workshop in addition to the post-workshop survey.
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After obtaining approval from the author’s Institutional Review Board, a convenience
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sample of nurse educators at an urban public university were recruited for this study. Invitations to participate in the study were distributed to nurse educators and adjunct faculty (N= 370) who
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taught in the undergraduate or graduate programs of a multi-site university. The university
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system has 11 senior colleges, seven community colleges and five graduate and professional school. For study inclusion, respondents had to teach nursing students. Two reminders were
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emailed to improve response rates. Although there was no direct monetary award for
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participating in the study, respondents who attended the METs did receive meals. One hundred respondents completed the pre-workshop survey. Thirty-seven respondents attended the METS and completed the post-workshop survey. The overall response rate was 27 percent. Data Analysis SPSS was used to analyze the data. A pre-post comparison of mean responses on the three different multicultural scales was conducted before participation in the cMET and after the session. Since each survey did not record respondent identifiers, it was not possible to directly link the pre- and post-responses. This resulted in the need to use an independent samples t test instead of the dependent samples version, despite the fact that the data represent repeated
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measures. This means that the tests presented are conservative, because the independent samples version of the t test has less power.
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Instrument
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For this study, an eight item demographic questionnaire and the Nurse Educator Multicultural Awareness and Practices Scale (MAPS) was created by the principle investigator
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and used along with an edited version of the Teacher Multicultural Attitude Survey (TMAS)
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(Ponterotto, Blancy, Greig & Rivera, 1998). Permission to use and edit the TMAS was obtained by Dr. Ponterotto. Content validity for the MAPS was established by soliciting three reviewers
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who had a background in the educational needs of URGs. The wording on some of the items of the TMAS was modified in order to make it relevant to nurse educators. The respondents were
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asked to complete the demographic questions in addition to the MAPS which consisted of 36
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items measuring 1) multicultural awareness, and 2) multicultural practices, and the TMAS which consisted of 10 items measuring 3) multicultural attitudes. Respondents answered the questions
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for each scale using a five-point Likert rating ranging from Strongly Disagree to Strongly Agree.
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Higher scores on the TMAS suggested a greater level of appreciation towards issues related to multicultural teaching. On the MAPS, higher scores on the multicultural awareness scale suggested that educators were more mindful of the multicultural factors that hinder or facilitate the academic success of URGs. Higher scores on the multicultural practices scale suggested a stronger tendency towards the adoption of multicultural teaching practices that considered the learning needs of URGs. Workshop The workshop began with a brief introduction to ME. This was followed by a discussion about the importance of diversity in nursing and the role of culturally responsive learning
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environments. Participants were then given an opportunity to reflect on their personal attitudes and assumptions toward teaching culturally diverse students. This was followed by an interactive
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mini-lecture on the dimensions of ME. Strategies that facilitated the implementation of an
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equitable pedagogy and culturally responsive teaching were shared. The evidence-based barriers to implementing ME were also discussed. Next, the participants were placed in small groups so
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they could collectively identify issues that might hinder their implementation of ME and discuss
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ways to overcome the potential barriers at their respective institutions. The workshop ended with the participants designing and sharing a syllabus that reflected their understanding of CME.
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Results
Table 1 provides frequencies for demographics in both the pre- and post-workshop
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samples. The modal age group in both samples was 46-68 (78% pre-workshop, 83.78% post-
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workshop). Females far outnumbered males at both points in time (92% pre-workshop, 97.3% post-workshop). The largest racial/ethnic group represented was African Americans, who made
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up 45% of the pre-workshop sample and 45.95% of the post-workshop sample. Caucasian
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educators comprised the next largest category (37% pre-workshop, 40.54% post-workshop). Asians, Hispanics, and other race categories combined represented less than 17% of both the preand post-workshop samples. 82% of the pre-workshop sample and 94.59% of the post-workshop sample spoke English as a first language. The majority of the participants reported that they had a master’s degree (65% percent of the pre-workshop sample and 64.86% of the post-workshop sample). The doctoral degree was the next most common degree. Table 2 summarizes the teaching backgrounds of the study respondents. A little over half (53%) of the pre-workshop sample and a little under half (48.65%) of the post-workshop sample had taught for less than 11 years. The remaining subjects were divided almost equally between
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having taught between 11 to 20 years and more than 20 years. The modal teaching environment was the undergraduate classroom (59% pre-workshop, 56.76% post-workshop) followed by
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undergraduate clinical (28% pre-workshop, 32.43% post-workshop). The remaining respondents
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taught at the graduate level, either in the classroom or a clinical setting. More than half of the respondents (56% pre-workshop and 54.05% post-workshop) had a degree in nursing education.
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The overwhelming majority of respondents reported that they taught Hispanic, African
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American, and other culturally diverse students (97% pre-workshop, 97.3% post-workshop). More than one-half of the participants (64% pre-workshop, 22% post-workshop) denied having
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attended a course on educating culturally diverse students. After reverse coding some of the MAPS and TMAS items, scores were determined by
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taking the average response across the constituent items. Summary statistics, along with
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reliabilities (Cronbach’s alpha) are displayed in Table 3. Using the common convention of .7 as an acceptable value for Cronbach’s alpha, two of the three scales provide reliable measures.
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Multicultural Attitudes
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The multicultural attitudes were measured using 10 items. It yielded an alpha of .7047 among the pre-workshop sample and .7588 among the post-workshop sample. Differences in means between the pre- and post- workshop measures for multicultural attitudes are evident. The average score measured prior to the workshop was 4.045 (SD = .453), which increased to a mean of 4.358 (SD = .448) following the workshop (Table 3). Figure 1 displays pre- and postworkshop means along with error bars representing 95% confidence intervals around the mean. In the case of the attitudes scales, the error bars are bounded away from each other. This suggests significant differences before and after participation, since the sampling variances do not overlap. The conservative independent samples t test (adjusting for unequal variance) confirms
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these results (Table 4) and reveal a significant difference on the attitudes scale (t = -3.54, df = 65, p < .001).
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Multicultural Awareness
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The multicultural awareness was measured using 25 items and produced a Cronbach’s alpha of .7545 among the pre-workshop observations and .7537 post-workshop. Table 3 shows
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differences in means between the pre- and post-workshop measures. The mean score on the
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awareness scale was 2.901 (SD = .321) prior to the workshop, which increased to 3.217 (SD = .313) after. Figure 2 displays pre and post-workshop means along with error bars representing
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95% confidence intervals around the mean. In the case of the awareness scale, the error bars are also bounded away from each other, suggesting significant differences before and after
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participation. The conservative independent samples t test (adjusting for unequal variance)
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confirms these results as well (Table 4). Means are significantly different on the awareness scale (t = -5.09, df = 66, p < .001).
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Multicultural Practices
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The multicultural practices were measured with 11 items, had lower reliability scores. Prior to the workshop, the items produced an alpha value of .684. Post-workshop, the value was .5589. A follow-up analysis considered whether dropping any item would lead to an increase in reliability. There were, however, no questions that clearly weighed down the value of Cronbach’s alpha, so none were deleted. Given the relatively low alpha, the practices scale likely consists of more noise than the other two scales, meaning it may be more difficult to find a significant result for this particular item. The distinction for significant differences before and after participation are not clear for the practices scale. The multicultural practices scale (Table 3), had a pre-workshop mean of
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3.285 (SD = .438) and a post-workshop mean of 3.432 (SD = .407). Although the post-workshop mean is higher, it has a large 95% confidence interval that overlaps with the sampling variance
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of the pre-workshop mean, thus suggesting it is not possible to statistically distinguish between
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the two groups (Figure 3). In addition, the conservative independent samples t test (adjusting for
significantly different (t = -1.79, df = 69, p = .077).
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Discussion
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unequal variance), revealed that the differences for the practices scale (Table 4) were not
The nation’s capacity to improve the quality of health care hinges upon educators who
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can create inclusive learning environments and graduate diverse nurses. Nurse educators play an instrumental role in the academic progression of students and are essential stakeholders in the
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initiatives that seek to eliminate racial and ethnic academic achievement gaps. Diversity
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initiatives could trigger conflicts between self and public interest (Stone, 2011). Therefore, it is imperative that administrators create safe environments that allow nurse educators to explore
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their attitudes, beliefs and practices.
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This study took place at an institution where the majority of faculty were Caucasian. However, the participants did not reflect that demographic. The session was predominantly represented by African American/Black educators. Why educators who attended the cMET session did not reflect the race and ethnic makeup of the total faculty population is a cause for concern and deserves further exploration. Some studies have revealed that African American/Black faculty are more likely to enter academia to serve as role models for URGs and support their academic success (Zajac, 2011). The African American educators’ internal commitment to support the success of URGs might explain why the sessions were widely attended by minority educators. The limited participation and presence of Caucasian faculty
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members might have stemmed from their belief that their instructional practices were already culturally responsive. In addition, race-related issues are oftentimes viewed as sensitive in
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nature. Some educators may not have attended because of the nature of the workshop. The
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workshops were conducted over the summer which could have also precluded the presence of many educators. Nevertheless, 40% of participants who attended the workshop were Caucasian.
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An overwhelming majority of participants taught URGs and the master’s degree was the
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highest earned degree for the majority of participants. A little over one-third of the participants (36%) attended a course on educating culturally diverse students. Both junior and senior
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educators attended the workshop which suggests that multicultural learning needs exist across the various age groups and regardless of the years of teaching experience.
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This study examined the impact that cMET had on the multicultural attitudes, awareness
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and practices of nurse educators. The findings revealed that the nurse educators’ awareness of factors that hinder or facilitate the academic success of URG’s were limited and attending the
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cMET strengthened their multicultural awareness. The respondents had high levels of
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appreciation towards multicultural teaching prior to the workshop. The cMET also strengthened their multicultural attitudes which could foster the adoption of practices that ensure educational equity. Positive assumptions about URGs is critical since negative beliefs could adversely affect student outcomes (Banks, 2006; Nieto & Bode, 2011; Chu, 2011). Further studies should seek to examine what correlations, if any, exist between cMET and the retention and graduation of URGs. The use of cMET did not significantly influence the practices that nurse educators use to teach culturally diverse students. Part of the reason for the non-significance in the practices scale may be due to its relatively low reliability, as shown in Table 2. It may nonetheless have turned
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out to be significant had it been possible to match the pre and post-workshop respondents so that the more powerful dependent samples t test could have been carried out. Plugging the sample
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estimates for the variance and standard deviations into the formula for standard error, it is
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possible to determine what the size of r must have been before the result would have been significant. Doing so showed that, if r had turned out to be .21 or higher, the test would have
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been significant. In other words, only a moderate correlation between the pre and post scores
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would have produced a significant dependent samples t test. This is a realistic possibility, albeit one that cannot be tested with the current data. A future study that retains identifiers to match pre
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and post scores will thus likely find significant changes, especially if the post-sample is larger. Educators play a critical role in helping institutions move the needle towards greater
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diversity in nursing. Thus, institutions must confirm that educators are aware of pedagogical
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practices that promote equity in the classroom and prepared to support a socially just curriculum (Nieto & Bode, 2011; Banks & Banks, 2013). Educators must also possess the capacity to meet
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the learning needs of URGs. Institutions should develop evaluation metrics that consider the
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educators proficiency in creating learning environments that promote educational equity. Administrators should provide funding for and access to training programs that strengthen the educators’ role in teaching diverse populations. The United States is rapidly becoming more ethnically and racially diverse. This heightens the need to ensure that nurse educators are cognizant of the factors that promote the academic success of URGs and possess the skillsets to teach them. The goal of achieving greater diversity in nursing may continue to extend beyond the professions’ reach unless reform efforts consider the multicultural attitudes, awareness and practices of educators.
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Limitations Several limitations of this study are acknowledged. First, caution should be taken when
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interpreting the data since factors outside the intervention could have influenced the findings.
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This study did not allow for measurement of the multicultural constructs over time and only looked at short-term influences. Secondly, this study did not distinguish between faculty and
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adjunct faculty. These groups could have different educational preparations and experiences
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which could have influenced outcomes. Thirdly, findings from this intervention were based on a small sample that was not randomly selected. The limited number of participants makes it
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difficult to generalize the findings. Future studies should include a larger sample that allows for stratified sampling. In addition, a longitudinal design should be used to reveal whether the
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multicultural changes persist over time. Lastly, the scale that was used to identify multicultural
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practices had a low reliability making it difficult to draw conclusions from it. The reliability of
Conclusions
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the scale could improve with a larger sample.
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In closing, diversity is crucial to assuaging health care disparities (U.S. Department of Health and Human Services, 2011). Training in ME is a plausible way to strengthen the nurse educators’ appreciation towards multicultural teaching and awareness of factors that hinder or facilitate the academic success of URGs. When educators have positive attitudes towards URGs and are knowledgeable about the learning needs of URGs, they have the power to translate that knowledge into effective instructional practices and create learning environments that support the academic success of all students (National Education Association, 2008; Ume-Nwagbo, 2012). Failing to adopt multicultural practices that address the learning needs of all students could disproportionately affect the academic success of URGs and undermine efforts to improve
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workforce diversity. Although the scale that was used to measure the construct of multicultural practices had a low reliability, nurse educators should examine the extent to which they use the
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pedagogical practices that promote educational equity.
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This cMET program has great implications for nursing science. Potential findings extend far beyond the academic success of URGs and embody the essence of Health Care Reform; to
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promote health equity by meeting the health care needs of all members. The use of cMET should
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strengthen the capacity of nursing programs to meet the learning needs of all students and graduate culturally diverse students who are prepared to care for underserved populations.
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Findings from this study should help to broaden the teaching capacity of educators and inform policies that seek to promote diversity and inclusion in nursing education. Improving the learning
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environment of all students should lead to the graduation of a diverse workforce that’s prepared
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to deliver high quality care and eliminate health care disparities.
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intergroup relations. Teachers College Record, 110(6), 1147-1181.
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Figure 1
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Table 1 Sample Demographics
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Age 30 or under 1 31-47 13 48-68 78 69 or over 8 Gender Male 8 Female 92 Race/Ethnicity Other (please specify 3 Asian 7 Black or African American 45 Hispanic/Latino 6 Native Hawaiian or Pacific Islander 1 White 38 English First Language Yes 82 No 18 Degree Baccalaureate 5 Master's 65 Doctorate 30 Note. Pre-Workshop N = 100, Post-Workshop N = 37
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Pre-Workshop N Percent
Post-Workshop N Percent
1 13 78 8
0 4 31 2
0 10.81 83.78 5.41
8 92
1 36
2.7 97.3
3 7 45 6 1 38
2 0 17 3 0 15
5.41 0 45.95 8.11 0 40.54
82 18
35 2
94.59 5.41
5 65 30
1 24 12
2.7 64.86 32.43
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Table 2 Teaching Background
18 11 8
48.65 29.73 21.62
59 28 10 3
21 12 3 1
56.76 32.43 8.11 2.7
56 44
20 17
54.05 45.95
97 3
36 1
97.3 2.7
36 64
15 22
40.54 59.46
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53 24 23
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Years Teaching in Academic Setting Less than 11 years 53 11-20 Years 24 More than 20 Years 23 Primary Level Taught Undergraduate classroom 59 Undergraduate clinical 28 Graduate classroom 10 Graduate clinical 3 Degree in Nursing Education? Yes 56 No 44 Currently Teach African American, Hispanics, etc.? Yes 97 No 3 Courses on Educating Culturally Diverse Students? Yes 36 No 64 Note. Pre-Workshop N = 100, Post-Workshop N = 37
Post-Workshop N Percent
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Pre-Workshop N Percent
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Table 3 Scale Summary Statistics
Pre-Workshop SD 0.453 0.321 0.438
Alpha 0.7047 0.7545 0.684
Table 4 Difference in Means Test for Pre versus Post Workshop Scales Mean SE Scale Difference Difference t Multicultural Attitudes -0.313 0.088 -3.54 Multicultural Awareness -0.316 0.062 -5.09 Multicultural Practices -0.147 0.082 -1.79
df 65 66 69
Scale Multicultural Attitudes Multicultural Awareness Multicultural Practices
# Items 10 25 11
Mean 4.045 2.901 3.285
Post-Workshop Mean SD Alpha 4.358 0.448 0.7588 3.217 0.313 0.7537 3.432 0.407 0.5589
p <.001 <.001 0.077
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Highlights for Examining the Impact of CMET
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Racial and ethnic diversity in the clinical workforce is critical to improving the quality of healthcare A deeper examination of race-related issues have revealed that some schools of nursing may not be able to meet the learning needs of some underrepresented groups Multicultural education (ME) is an educational reform project that has been used in teacher education programs to promote educational equity and improve the academic outcomes of all students
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