How Different Can You Be and Still Survive? Homogeneity and Difference in Clinical Nursing Education

Abstract

The article focuses on a component of a three-year institutional ethnography regarding the construction of cultural diversity in clinical education. Students in two Canadian schools of nursing described being a nursing student as bounded by unwritten and largely invisible expectations of homogeneity in the context of a predominant discourse of equality and cultural sensitivity. At the same time, they witnessed many incidents, both personally and those directed toward other individuals of the same culture, of clinical teachers problematizing difference and centering on difference as less than the expected norm. This complex and often contradictory experience of difference and homogeneity contributed to their construction of cultural diversity as a problem. The authors provide examples of how the perception of being different affected some students' learning in the clinical setting and their interactions with clinical teachers. They will illustrate that this occurred in the context of macro influences that shaped how both teachers and students experienced and perceived cultural diversity. The article concludes with a challenge to nurse educators to deconstruct their beliefs and assumptions about inclusivity in nursing education.

Cultural Competence in Health Care

“…[34][35][36] In this context, students may not feel safe in being different, or they may feel silenced when expressing differing viewpoints in the culture of health care professional education. 37 Participants noted that the development of intrapersonal selfawareness required a "safe" context (including self-compassion), could be "painful" to get in touch with, and that discomfort could generate a resistance toward deeper selfawareness.…”

How can we help minority nursing students?

“…One such difference comes from ESL students' unfamiliarity with the English language. Nursing faculty may label students as slow when their need to translate what they heard, prepare an answer, and translate it back to answer in English is the issue [10] . Specific problems students experienced in clinical included unclear pronunciation, lack of initiative in communicating with staff, nodding and smiling when asked to do something rather than responding verbally, and failing to explain and reassure patients when providing care [11] .…”

“…Nurses sent messages to students, generally via the instructor, if they perceived that cultural differences interfered with the work of the staff in the clinical setting and that students should mediate this by blending in with others [10] . These differences made the ESL students feel that they did not belong in the clinical setting.…”

“…The individual and institutional interactions in clinical nursing education privileged whiteness and marginalized those whose differences challenged the ability of teachers and nurses to enact their role [10] . Fortunately, patients also influenced students' sense of belonging and helped students feel satisfied if they contributed to patient care [8] .…”

“…Paterson et al felt that a limitation of the literature on cultural diversity in nursing education is generally presented as if instructors need to learn how to relate to students of minority cultural groups so that these students can adapt to the expectations and practices of the predominantly Euro-white female faculty [10] . Few researchers have attempted to break down the privilege of whiteness embedded in nursing education-something that definitely needs attention [10] .…”