Short-Term Outcomes of a Diversity, Equity, and Inclusion Institute for Nursing Faculty

Abstract

Background:
Student populations in the United States are increasingly diverse, prompting the need to make learning environments in schools of nursing more inclusive. Training for faculty is needed to support this work; however, evidence regarding best practices to make classrooms more inclusive is lacking.

Method:
A 3-day Diversity, Equity, and Inclusion (DEI) Institute was developed and conducted to create inclusive learning environments; facilitate crucial conversations on racism and other -isms, especially in the context of nursing and health equity; and practice these skills and develop or transform at least one actual class activity.

Results:
DEI Institute satisfaction and impact were overwhelmingly positive, and statistically significant increases in DEI-related teaching self-efficacy were observed post-Institute (p values ranging from .0004 to < .0001).

Conclusion:
The DEI Institute is one example of a successful approach that can create inclusive learning environments and address issues related to health equity. [J Nurs Educ. 2019;58(11):633-640.].

Full text

Short-Term Outcomes of a Diversity, Equity,
and Inclusion Institute for Nursing Faculty
M. Rebecca O’Connor, PhD, RN; Wendy E. Barrington, PhD;
Diana Taibi Buchanan, PhD, RN; Dan Bustillos, PhD; Meghan Eagen-Torkko, PhD, ARNP;
Anne Kalkbrenner, MN, RN; Sharon S. Laing, PhD; Kerryn W. Reding, PhD, RN; and
A.B. de Castro, PhD, RN, FAAN
Despite altruistic motives and a desire by university fac-
ulty to create inclusive learning environments in health
sciences education, students from marginalized groups
often report experiences of distress from microaggressions,
bias, and/or exclusion in educational settings (Macy Founda-
tion, 2018; O’Connor, 2017; Sue et al., 2013). In response to
this, the American Association of Colleges of Nursing (AACN)
has called on academic nursing programs to advance diversity,
equity, and inclusion (DEI) efforts in order to improve the qual-
ity of nursing education through diverse and inclusive educa-
tional environments and prepare nurses to effectively care for
an increasingly diverse population in the United States (AACN,
2017). Specifically, the AACN (2017) states that:
When diversity is integrated within inclusive educational
environments with equitable systems in place, assumptions
are challenged, perspectives are broadened, and socialization
across a variety of groups occurs, resulting in intellectual and
cognitive benefits for all learners. (p. 2)
A 2018 Josiah Macy Jr. Foundation report titled “Improving
Environments for Learning in the Health Professions” echoes
the call by the AACN and defines learning environments as
“the social interactions, organizational cultures and structures,
and physical and virtual spaces that surround and shape par-
ticipants’ experiences, perceptions, and learning [where] every
participant is both a learner and a teacher” (p. 36). Among its
recommendations, the Macy Foundation (2018) report calls for
team-based training to establish the trust, knowledge, and skills
necessary to recognize and mitigate the effects of explicit and
implicit bias in learning environments; obtaining requisite skills
to successfully engage historically marginalized groups; and the
development of self-awareness and reflective practice. The re-
port also asserts that learning environments should consider:
safety (including both physical and psychological), engage-
ment (promoting collaborative learning), connectedness (foster-
ing a sense of belonging), infrastructure (providing resources
and leadership), access (providing a variety of resources with
consideration of the Americans with Disabilities Act and equity
issues), and climate (promoting inclusion). (Barton, 2018, p. 516)
Reports and position statements by organizations such as the
AACN and the Macy Foundation highlight the need to make
health sciences educational environments more inclusive as a
requisite step to addressing the inequity and exclusion experi-
enced by students of diverse identities. Nursing and other health
sciences faculty and leaders must commit to and dedicate the
necessary resources to this charge if inclusive learning envi-
ABSTRACT
Background: Student populations in the United States are
increasingly diverse, prompting the need to make learning
environments in schools of nursing more inclusive. Training
for faculty is needed to support this work; however, evidence
regarding best practices to make classrooms more inclusive is
lacking. Method: A 3-day Diversity, Equity, and Inclusion (DEI)
Institute was developed and conducted to create inclusive
learning environments; facilitate crucial conversations on rac-
ism and other -isms, especially in the context of nursing and
health equity; and practice these skills and develop or trans-
form at least one actual class activity. Results: DEI Institute
satisfaction and impact were overwhelmingly positive, and
statistically signicant increases in DEI-related teaching self-
ecacy were observed post-Institute (p values ranging from
.0004 to < .0001). Conclusion: The DEI Institute is one exam-
ple of a successful approach that can create inclusive learning
environments and address issues related to health equity. [J
Nurs Educ. 2019;58(11):633-640.]
Dr. O’Connor is Assistant Professor, Dr. Barrington is Assistant Profes-
sor, Dr. Buchanan is Associate Professor, Ms. Kalkbrenner is Lecturer, Dr.
Reding is Associate Professor, and Dr. de Castro is Associate Dean for Di-
versity, Equity, and Inclusion, University of Washington School of Nursing,
Seattle, Dr. Bustillos is Assistant Professor, and Dr. Eagen-Torkko is Assis-
tant Professor, University of Washington School of Nursing and Health
Studies, Bothell, and Dr. Laing is Assistant Professor, University of Wash-
ington Nursing and Healthcare Leadership, Tacoma, Washington.
The authors acknowledge the generous support of the University of Wash-
ington’s Race and Equity Initiative, the University of Washington’s Diversity
Seed Grant Program, and the University of Washington School of Nursing’s
Innovative Educator Fellowship Program that made this work possible. The
authors also thank their colleagues who participated in the DEI Institute and
were willing to engage in dicult conversations, and whose daily work helps
to create inclusive learning environments and develop nurses who will provide
equitable care for all.
The authors have disclosed no potential conicts of interest, nancial
or otherwise.
Address correspondence to M. Rebecca O’Connor, PhD, RN, Assistant
Professor, University of Washington School of Nursing, Box 357262, Se-
attle, WA 98195; e-mail: rebeccao@uw.edu.
Received: June 4, 2019; Accepted: August 6, 2019
doi:10.3928/01484834-20191021-04
Journal of Nursing Education • Vol. 58, No. 11, 2019 633

ronments are to be realized. Although transformational change
is essential to creating truly inclusive environments, it can be
challenging—particularly when change also involves address-
ing institutional racism, power differences, privilege, and/or
implicit biases. For example, antiracism and education scholar
Derald Wing Sue (2013) stated that learning to effectively fa-
cilitate conversations on race “in education is especially urgent
as difficult dialogues on race become unavoidable, and well-
intentioned teachers find themselves unprepared to deal with
the explosive emotions that result in polarization of students”
(p. 664). Faculty have expressed that they do not feel prepared
to address critical conversations on topics such as power, privi-
lege, dominance, or institutionalized racism, and professional
development on these topics is needed to support this work
(Booker, Merriweather, & Campbell-Whatley, 2016; Mayo &
Larke, 2011). Research by Sue et al. (2009) reveals that engag-
ing in conversations about racism is particularly challenging for
White faculty due to fears related to revealing personal biases/
prejudices or losing control of classroom discussions and a lack
of skills and knowledge, such as the ability to recognize or un-
derstand difficult discussion dynamics.
The context of nursing and health sciences education pres-
ents challenges to addressing DEI topics as well. First, faculty
lack diversity—85% of nursing faculty nationally are White
(National League for Nursing, 2015). The nature of nursing
practice also makes the need to have constructive conversa-
tions and self-reflection particularly urgent given that schools
of nursing (SONs) aim for not only an inclusive educational en-
vironment but for preparation of nurses who can provide equi-
table care for a diverse population. Thus, preparation of nurses
should include an understanding about the influence of racism
and other systems of marginalization and oppression, critical
self-reflection, and lifelong learning. Accordingly, training that
specifically addresses DEI in the classroom and curriculum is
needed for faculty. It is important to note that our efforts to de-
velop such a DEI training were concurrent with a number of
other school-level initiatives (e.g., development and implemen-
tation of the SON’s DEI strategic plan, establishing an Office of
DEI and hiring a permanent Associate Dean of DEI) and univer-
sity initiatives (e.g., the University of Washington [UW] Race
and Equity Initiative) to systematically address marginalization,
discrimination, and inequities in education and nursing.
There is a dearth of research on the effectiveness of faculty
training to improve the inclusivity of the educational experi-
ence in higher education. A search of PubMed®, CINAHL®,
UW libraries, and Google™ Scholar using the terms faculty, di-
versity, equity, inclusion, and training identified two qualitative
studies involving faculty trainings that focused on improving
the educational experience for marginalized students and one
quantitative study that specifically targeted gender bias in the
classroom. Booker et al. (2016) conducted a week-long faculty
training to incorporate culturally diverse teaching and assess-
ment strategies based on multicultural education frameworks
(e.g., Banks & Banks, 2013; Grant & Sleeter, 2011). Training
content included enhancing participants’ awareness of inequi-
ties and importance to student experience, campus resources,
and examples of how to make teaching more culturally diverse
(Booker et al., 2016). Focus groups and interviews revealed that
faculty developed a greater understanding of issues related to
diversity, became more aware of their language and personal
impact in relation to course materials, and were intentional in
their approach to increase inclusion in their teaching (Booker et
al., 2016). Students stated that classrooms of faculty attendees
were more inclusive, diversity was visible, and course activities
added to their personal and professional growth and acceptance
of otherness (Booker et al., 2016). Mayo and Larke (2011)
described an initiative that sought to have a curriculum in all
disciplines reflect multicultural best practices at a large public
university. Training content included increasing participants’
awareness of the multicultural nature of the university, diverse
learning styles and teaching approaches, discipline-specific
content ideas, culturally enriched teaching techniques, cultur-
ally sensitive assessment strategies, effective intercultural and
cross-cultural communication, and communication during dif-
ficult moments (Mayo & Larke, 2011). On training evaluations,
faculty reported that the training was beneficial and would help
them become more inclusive in their classrooms, whereas stu-
dents of faculty who completed the training in one department
responded that course readings reflected diverse voices (Mayo
& Larke, 2011). Finally, Moss-Racusin et al. (2016) conducted
a 2-hour bias workshop for life sciences faculty attending a
National Academies Summer Institute for undergraduate edu-
cation. Content included an active-learning approach, present-
ing diversity as a shared versus individual responsibility, and
evidence-based interventions to address gender bias (Moss-
Racusin et al., 2016). Compared to 2 weeks preworkshop, par-
ticipants reported an increased awareness of gender bias (p =
.04), expressed less gender bias (p = .03), and expressed a great-
er willingness to engage in actions to reduce gender bias (p <
.001; Moss-Racusin et al., 2016).
Although limited research has explored the influence of
faculty trainings on inclusivity in classrooms, other research
has studied the effectiveness of anti-bias training more gen-
erally. For example, Devine et al. (2017; Carnes et al., 2015)
have shown short- and long-term effectiveness of a prejudice
habit-breaking intervention to address anti-Black bias among
university students and gender bias among faculty in science,
technology, engineering, math, and medical (STEMM) de-
partments. The prejudice/bias habit-breaking intervention is
based on adult learning and behavior-change principles, and
the training approach conceptualizes prejudice/bias as a habit
that requires time, motivation, and effort to change (Devine et
al., 2017). Training content focused on increasing awareness,
understanding the consequences of prejudice/bias, and learn-
ing evidence-based strategies shown to effectively reduce bias
(i.e., individuation, perspective-taking, stereotype replacement,
counter-stereotype imaging, and increased intergroup contact;
Devine et al., 2017). Devine et al. showed that among 301
faculty in 46 STEMM departments at a large public research
university who received the 2.5-hour gender bias training, sta-
tistically significant increases were observed in personal bias
awareness (p = .009), internal motivation (p = .028), gender
equity self-efficacy (p = .026), gender equity positive outcome
(p = .039) 3 days posttraining, and in personal bias awareness
(p = .001), and gender equity self-efficacy (p = .013) 3 months
posttraining, compared with 1,153 faculty in 46 control depart-
634 Copyright © SLACK Incorporated

ments who did not receive the training (Carnes et al., 2015).
In addition, compared with control departments, STEMM de-
partments who received the intervention increased female fac-
ulty hires by 15% (p = .07) 2 years posttraining (Devine et al.,
2017). Another randomized controlled trial of 292 non-Black
university students using Devine’s prejudice-breaking interven-
tion also showed long-term behavioral effects related to beliefs
and attitudes toward Black individuals for students who re-
ceived the intervention compared with controls at 2 weeks—for
example, more likely to identify bias as wrong in themselves or
others (odds ratio [OR] = 2.468, 95% confidence interval [CI] =
[1.278, 4.984]) and 2 years after the intervention (more likely to
publicly disagree with the statement “stereotypes are harmless”
(OR = 4.15, 95% CI = [1.51, 12.84]; Forscher, Mitamura, Dix,
Cox, & Devine, 2017).
To address the need to develop faculty knowledge and ef-
fectiveness in addressing DEI topics in teaching, we developed
the DEI Institute based on the current evidence reviewed above
and assessed the short-term outcomes of the DEI Institute using
quantitative research methods. Specifically, the objectives of
the DEI Institute were to provide SON faculty with the knowl-
edge and skills to create truly inclusive learning environments,
facilitate crucial conversations on racism and other -isms, and
incorporate DEI topics throughout all curricula.
METHOD
Exemption was granted from the UW Institutional Review
Board to collect anonymous data from DEI Institute partici-
pants before and after the DEI Institute.
DEI Institute Planning, Development,
and Training of Mentors
University-level funding was obtained, and 25% full-time
equivalent was designated to support the planning and develop-
ment of the DEI Institute. To guide the development of DEI In-
stitute content (Table 1), learning objectives and outcomes were
iteratively developed during the fall quarter 2017 through feed-
back from multiple stakeholders including students, faculty, and
school-level and university-level leadership. Based on prior re-
search discussed above (e.g., increasing awareness from Devine
et al., 2017) and stakeholder feedback (e.g., faculty requests for
opportunities to practice necessary skills), DEI Institute activities
targeted awareness-building, creating inclusive environments for
TABLE 1
Overview of DEI Institute Activities and Objectives
Example Activities Content Delivered by Associated Objectives
Day 1
Read aloud anonymous rst-person instances
of discrimination experienced by SON students
and discuss how they impact the SON student
experience
UW SON Innovative Educator Fellow 1) Create inclusive learning environments for all
students
Share examples of how to generally create
inclusive learning environments
UW Center for Teaching and Learning
sta
1) Create inclusive learning environments for all
students
Self-reection, small and large group
activities to understand privilege and address
microaggressions
Professional Facilitators 2) Facilitate crucial conversations on racism and
other -isms, especially in the context of nursing
and health equity
Day 2
Demonstrate and role-play strategies (e.g.
how to interrupt, how to address audience
resistance) to facilitate conversations on racism,
other -isms in small and large groups
Professional Facilitators 2) Facilitate crucial conversations on racism and
other -isms, especially in the context of nursing
and health equity
Day 3
Role-play strategies to facilitate dicult
conversations using the HEALS model and real
classroom examples
UW SON DEI mentors 3) Practice how to respectfully and eectively
integrate diverse voices/individuals/communities
into our nursing curriculum to include the actual
development or transformation of at least one
class activity in small groups
Create new or transform existing classroom
activity that incorporates principles of DEI
independently and in small groups with DEI
mentor support
UW SON DEI mentors
Note. DEI = diversity, equity, inclusion; SON = School of Nursing; UW = University of Washington.
Journal of Nursing Education • Vol. 58, No. 11, 2019 635

diverse learners, managing difficult conversations on racism and
opportunities to practice these skills, incorporating DEI into cur-
riculum, normalizing mistakes when engaging in DEI work and
how to handle mistakes with humility, and providing information
on existing resources (Booker et al., 2016; Devine et al., 2017;
Mayo & Larke, 2011; Sue, 2013). Specific DEI Institute content
was then iteratively developed over the winter and spring quarters
2018 in collaboration with SON DEI mentors.
Additional university-level funding was also secured to train
a group of SON DEI faculty mentors to support the integra-
tion of DEI into curriculum. Training multiple faculty mentors
was intentional to (a) build capacity among multiple individual
mentors across all three UW campus locations, (b) develop
multiple individuals who faculty/students can seek out for sup-
port in DEI work and who are not in managerial or administra-
tive roles, (c) demonstrate that DEI work does not rest with just
a few individuals, and (d) develop a network of support and
resources between the DEI mentors. The nine faculty mentors
were identified based on their prior track record of incorporat-
ing DEI into their teaching practices. DEI mentors received
additional DEI training together, iteratively helped develop the
DEI Institute content, cofacilitated day 3 of the Institute, and
continue to serve as DEI resources for their respective campus
locations. DEI mentor training included a broader 5-hour train-
ing in inclusive teaching strategies; objectives included:
• How to model and facilitate cultural humility in the class-
room/curriculum, led by the UW Center for Teaching and
Learning staff.
• How to recover when things go wrong in the classroom, led
by a UW educational consultant, and a 3-hour training on
a specific method to initiate difficult conversations in the
classroom, led by University of California San Francisco
(UCSF) SON faculty (The HEALS [Halt, Engage, Allow,
Listen, Synthesize] model; UCSF SON, 2017).
Based on DEI Institute objectives, outcomes, and existing
literature, DEI mentors refined the content of the Institute dur-
ing the latter portion of the planning year. In recognition of their
time and effort, DEI mentors were provided a modest hono-
rarium.
DEI Institute
The DEI Institute was scheduled for the final 3 weekdays
(Wednesday through Friday) before the start of fall quarter 2018
in an effort to minimize conflicts with beginning of academic
year retreats and teaching obligations. All SON faculty and in-
structors of any rank across all three UW system campuses were
invited to attend. There are 112 full-time faculty and lecturers
and approximately 50 adjunct/clinical instructors at all three
SON campus locations.
Content experts delivered specific components of the DEI
Institute in order to provide multiple viewpoints and relevant
expertise (Table 1). During the first half of day 1, the SON in-
novative educator fellow facilitated an exercise where partici-
pants read aloud anonymous experiences of discrimination by
her students in the SON to establish the need to create more
inclusive learning environments and staff from the UW Center
for Teaching and Learning–facilitated inclusion activities. Dur-
ing the second half of day 1 and day 2, local professional social
justice facilitators led activities on how to facilitate conversa-
tions on racism and other -isms. During the first half of day 3,
SON DEI mentors facilitated training on how to address “hot
moments” in the classroom using the HEALS model based on
prior HEALS training by the mentors. During the second half
of day 3, participants were given time to individually develop
or transform a class activity that incorporated elements of DEI.
DEI mentors served as resources to participants and facilitated
small-group discussions on how to effectively deliver these ac-
tivities based on the mentors’ prior training and experience with
incorporating DEI in their own teaching.
Activities across all 3 days included a mix of active-learning
content delivery, individual reflection, and small and large
group activities. Of critical importance to self-efficacy, acquisi-
tion of knowledge and skills, and ultimately behavior change,
we incorporated opportunities for participants to role-play vari-
ous scenarios throughout the DEI Institute (e.g., addressing re-
sisters in an audience, addressing microaggressions during a
class) and to work individually and collectively to develop an
activity that effectively incorporates DEI. To respect the intel-
lectual property of facilitators, in-depth descriptions of specific
DEI Institute activities will not be described in this article; how-
ever, some examples are provided in Table 1, and additional
extensive resources can be found in Diversity, Equity, and In-
clusion: Strategies for Facilitating Conversations on Race by
Hollins and Govan (2015). Because we did not want to make at-
tendance mandatory due to potential paradoxical outcomes (see
Discussion below regarding the potential for diversity trainings
to create more bias among attendees), we instead provided a
$500 honorarium and daily certificates of completion to docu-
ment training hours as incentives for attending all 3 days of the
DEI Institute.
Measures
Demographic Variables. Confidentiality is imperative when
collecting data on sensitive topics such as DEI from colleagues
who work together and have differing levels of power. Thus, we
did not ask participants to divulge any demographic characteris-
tics (identifiable or anonymous) because some attendee catego-
ries (e.g., racial/ethnic minorities, men, certain age groups) may
only include one to two individuals, thus making them identifi-
able. Short-term outcomes of the DEI Institute were assessed
by participants’ teaching self-efficacy related to DEI measured
at the beginning of day 1 and the end of day 3 of the Institute,
in addition to participants’ satisfaction with and impact of the
DEI Institute.
DEI Teaching Self-Efficacy. Self-efficacy—defined as
what skills an individual perceives she or he has or what
skills can be effectively implemented in a given situation
(DeChenne, Koziol, Needham, & Enochs, 2015)—is widely
accepted to be a prerequisite to behavior change (Bandura,
1991; Carnes et al., 2015). Our ultimate outcome of interest
is to determine whether behavior change among DEI Institute
participants results in more inclusive learning environments
for nursing students, measured by participant reports and
student-reported measures of inclusion from course evalua-
tions over the 2018–2019 academic year compared with the
2017–2018 academic year. Given that self-efficacy is requi-
636 Copyright © SLACK Incorporated

site for behavior change, we identified DEI-related teaching
self-efficacy as our main short-term outcome of interest. We
were unable to identify a DEI-specific teaching self-efficacy
measure. Thus, we adapted a previously validated measure
developed by DeChenne et al. (2015) and used with gradu-
ate teaching assistants in STEM. The 18-item instrument’s
reliability has been determined to be very good (Cronbach’s
a = .90). We adapted each item by adding “DEI content” or
“related to DEI content” as appropriate to the end of each
question (e.g., “Make students aware that I have a personal
investment in them and in their learning” became “Make stu-
dents aware that I have a personal investment in them and in
their learning related to DEI content”). We used 17 of the 18
instrument items (the last item “Spend the time necessary to
plan my classes” was not included because the DEI Institute
would not affect this). DEI teaching self-efficacy was ob-
tained by self-administered survey before the start of day 1
of the Institute and at the end of day 3 of the Institute.
DEI Institute Evaluation. Seven Likert scale questions and
four open-ended questions were used to evaluate participants’
satisfaction with and impact of the DEI Institute (Table 2).
Evaluation questions were adapted from the work by Hollins
and Govan (2015), Diversity, Equity, and Inclusion: Strategies
for Facilitating Conversations on Race. Institute evaluation was
measured in person at the end of each day and/or speaker of the
DEI Institute.
Data Analysis
Distributions of the 17 DEI-related self-efficacy variables
were examined for all participants who completed pre-Institute
measures at the beginning of day 1 (N = 43) and post-Institute
measures at the end of day 3 (N = 33). Differences in distribu-
tions were evaluated using the nonparametric Kolmogorov–
Smirnov test for equality of distributions (Table A; available
in the online version of this article). Domains of self-efficacy
were then created to be consistent with DeChenne et al. (2015)
and included teaching orientation (questions 1, 5, 11), engag-
ing students (questions 2, 4, 7, 8), supporting students and
the classroom environment (questions 3, 6, 9, 10), evaluating
students (questions 12, 13, 14), and designing curricula (ques-
tions 15, 16, 17). Self-efficacy scores were created for each
of the five domains by summing responses to corresponding
survey items, and mean scores were calculated for each do-
main pre- and post-Institute (Table 3). Differences in mean
scores pre- and post-Institute were examined among partici-
pants with complete data only (N = 28) and tested using paired
t tests (Table 3). All analyses were conducted using STATA®
SE version 13.0. Means for satisfaction with the DEI Institute
were calculated from pooled satisfaction measures for all in-
dividual DEI Institute speakers.
RESULTS
Forty-four faculty and instructors from three UW SON
campuses attended the DEI Institute—approximately 27% of
all full-time and part-time faculty and instructors. Forty-two
of the 44 participants attended all 3 days of the Institute. Sat-
isfaction with the DEI Institute was consistently high among
the seven Likert-scale measures, with mean scores ranging
from 1.49 to 1.66 (1 = strongly agree to 7 = strongly disagree;
Table 2). Participants almost exclusively shared the perspec-
tive that the impact of the DEI Institute was very positive (e.g.,
“Thank you so much for this opportunity—it was awesome to
have these resources invested in me as faculty”) and plan on
changing their teaching to incorporate DEI content (e.g., “Try
HEALS”; Table 2). DEI-related teaching self-efficacy signifi-
cantly increased for 13 of 17 items on the Self-Efficacy mea-
sure immediately after the DEI Institute, compared with im-
mediately before the Institute (Table A). Analysis also shows
increases in the aggregated post-Institute means for each of the
five DEI-related teaching self-efficacy domains compared with
pre-Institute measures (p values ranging from .002 to < .0001)
(Table 3).
DISCUSSION
Rigorous research is lacking related to efforts that seek to
create inclusive learning environments (Booker et al., 2016;
Macy Foundation, 2018; Mayo & Lark, 2011; Moss-Racusin
et al., 2016; Sue et al., 2009). To our knowledge, only three
previous studies (Booker et al., 2016; Mayo & Larke, 2011;
Moss-Racusin et al., 2016) examining the effects of faculty
trainings on inclusive classroom environments have been pub-
lished. Although these studies provide important information
on the topic, their findings are either limited to qualitative re-
ports or focused only on gender bias. The current study begins
to address this gap by providing quantitative assessment of the
short-term outcomes of a 3-day DEI faculty training designed to
create more inclusive learning environments in an SON.
Faculty and instructor participants uniformly rated their sat-
isfaction with the DEI Institute highly and expressed that they
believed the DEI Institute had a positive influence on them
and their teaching in open-ended questions. These findings are
consistent with the research done by Booker et al. (2016) and
Mayo and Larke (2011). Further, increases in post-Institute DEI
teaching self-efficacy were noted for nearly all individual items
of the DEI Teaching Self-Efficacy measure and all five self-
efficacy domains, compared with pre-Institute levels. It should
be noted that high pre-Institute measures may explain why pre-
and post-differences were not significant for three other self-
efficacy items: the majority of attendees responded that they
agree or strongly agree with the statement in questions 5, 6,
and 11 before the DEI Institute (65.7%, 64.5%, and 83.1%, re-
spectively), leaving little room for higher ratings after the DEI
Institute. These results highlight the promise that interventions
such as the one described here must create more inclusive learn-
ing environments. Additionally, given that we were unable to
identify measures of quantitative outcomes related to trainings
focused on faculty and inclusive learning environments in exist-
ing literature, our findings can inform future similar work.
As noted previously, it is important to acknowledge that sig-
nificant institutional support at both the university- and school-
level facilitated the success of the DEI Institute. The AACN
(2017), the Macy Foundation (2018), and others have identified
institutional support as a critical element and requisite to en-
gage in meaningful DEI work (Dobbin & Kalev, 2018; Mayo
Journal of Nursing Education • Vol. 58, No. 11, 2019 637

& Larke, 2011; Penner, Blair, Albrecht, & Dovidio, 2014).
Another key factor for success was the designated 25% full-
time equivalent for planning and development of DEI Institute
objectives, content, and outcomes. Finally, the commitment
and participation of the DEI faculty mentor group from across
three SON university campuses was critical to the successful
development, implementation, and follow-up work of the DEI
Institute.
Another important aspect to consider in the success of the
DEI Institute is that participants self-selected to attend the
TABLE 2
Summary of DEI Institute Evaluations
Question N
Mean Score
(1 = Strongly Agree,
6 = Strongly Disagree) Example Quotes
The presenters clearly communicated the subject
matter
22 1.49
The presenters were skilled in facilitating discussions
and activities
22 1.54
To the extent circumstances permitted, the
presenters encouraged interaction among
participants and allowed time for questions and
answers
22 1.66
Discussion, exercises, and presentations stimulated
me to think about the subject matter to a greater
extent than I had before
22 1.56
The presentation was well organized and activities
clearly emphasized major points
22 1.50
The content of the presentation enhanced my
overall understanding of the topic
22 1.65
The materials provided were helpful 22 1.66
What aspects of the Summer DEI Institute
contributed most to your learning?
20 “Deep, meaningful conversations and interactions”
“1) Modeling skills to address microaggressions
and biases that are presented in class. 2) Ability to
role-play.”
How could the Summer DEI Institute be improved? 16 “More time to debrief after each deep, meaningful
conversation/interaction.”
“More time to connect with the group as a whole;
explicitly addressing power dierentials in the
room”
What other DEI professional development would
you like to participate in?
11 “1) I would love to have faculty report back in
6 to 8 months and tell us what they have tried,
what worked well and not so well. 2) Have a
retreat with one of the sister campuses. 3) Faculty
should publish and disseminate their DEI teaching
pedagogy at conferences.”
“Lots! LGBTQ issues—seems like there is a major
lack of knowledge on these issues. We should all
have the certication from the Q Center.”
What is one thing you will do dierently or one
strategy you will try as a result of what you learned
in the Summer DEI Institute?
13 “Take more risks and more directly and
courageously take on these conversations.”
“1) Will be more aware of the importance
of addressing issues and having dicult
conversations. 2) Will be using HEALS.”
Note. DEI = diversity, equity, inclusion. Adapted from “Diversity, Equity, and Inclusion: Strategies for Facilitating Conversations on Race,” by C. D. Hollins and I. M. Govan,
2015, London, United Kingdom: Rowman & Littleeld. Copyright 2015 by C. D. Hollins and I. M Govan. Adapted with permission.
638 Copyright © SLACK Incorporated

training. Although this selection bias may limit the findings of
this study to all nursing faculty (see Limitations), we made the
intentional decision to not make the DEI Institute mandatory.
Rather, we chose to offer a $500 honorarium and certificates of
completion that can be used toward continuing education hours
to encourage participation. Our decision to make the DEI Insti-
tute optional was based on substantial evidence that suggests
mandatory diversity trainings may have the opposite effect and
actually cause some participants to exhibit more discriminatory
behaviors or increase bias (Anand & Winters, 2008; Dobbin &
Kalev, 2018; Kulik, Pepper, Roberson, & Parker, 2007; Legault,
Gutsell, & Inzlicht, 2011; Moss-Racusin et al., 2016; Paluck &
Green, 2009).
Although the DEI Institute was widely viewed as a suc-
cess in terms of participant satisfaction, perceived impact, and
statistically significant increases in DEI-related teaching self-
efficacy, areas of improvement were also identified. An infor-
mal debrief discussion with participants was facilitated by DEI
mentors at the end of day 3. During the discussion, DEI mentors
asked participants what worked well during the DEI Institute
and what could be improved, and a few participants shared chal-
lenges in how they experienced two Institute activities. These
concerns were further discussed among DEI faculty mentors
and will be addressed in the future as appropriate. Additionally,
in Institute evaluations, participants expressed a desire for more
time to debrief after each “deep, meaningful conversation/in-
teraction” (referring to both small- and large-group activities),
more time to connect with the group as a whole, and that power
differentials in the room be explicitly acknowledged. In future
DEI Institutes, we will conduct debrief sessions at the end of
each day, we will ask that participants switch tables each day to
increase connections between them, and we will acknowledge
power differentials and how these may affect the experience of
participants at the beginning of day 1.
Creating inclusive learning environments requires that fac-
ulty and instructors effectively address complex and difficult
topics such racism and power, which cannot be achieved by a
singular event or type of approach (Carnes et al., 2015; Dob-
bin & Kalev, 2018; Penner et al., 2014; Williams & Moham-
med, 2013). Multiple resources and activities in the SON will
continue to support the work started at the DEI Institute. The
SON’s Office of DEI sponsors additional training opportuni-
ties on various DEI topics. Quarterly brown-bag lunch events
led by DEI mentors serve as open forums to discuss challenges
and successes related to incorporating DEI into the curriculum,
share ideas and resources, and discuss hot topics such as free
speech on campuses. Additionally, DEI mentors continue to
serve as informal peer advisors for faculty and staff and provide
colleague teaching evaluations or advice upon request.
LIMITATIONS
Although outcomes of the DEI Institute were positive and
suggest that this approach holds much promise, some limita-
tions to the current study exist. First, this study included only
one SON. Activities to prioritize and promote DEI throughout
the UW SON may have created an environment where faculty
feel more comfortable engaging in DEI work and attending the
Institute, compared with other schools that do not have DEI
initiatives. Second, because we prioritized participant anonym-
ity, a lack of demographic data precluded the ability to identify
potential confounding factors associated with DEI Institute out-
comes. Third, we did not independently assess the reliability
and validity of the adapted self-efficacy measure. However,
we believe that the adaptations made to the instrument (adding
“DEI content” or “related to DEI content” to the end of each
item) are not likely to substantially affect the meaning of each
item; therefore, assuming similar reliability of the adapted mea-
sure to the original measure is reasonable. Finally, DEI Institute
participants were self-selected, so it is likely that faculty who
were more willing to integrate DEI into their curriculum were
more likely to attend the Institute. Thus, it is unclear whether
DEI Institute outcomes would be the same for faculty who are
hesitant to incorporate DEI into their curriculum.
CONCLUSION
There is a critical need to make nursing—and all higher
education instruction—truly inclusive for increasingly diverse
student populations. Faculty training to develop the knowledge
TABLE 3
Change in DEI Group Self-Ecacy Scores Pre- and Postparticipation in the DEI Institute
Preparticipation (N = 28) Postparticipation (N = 28)
Variable Mean SD Mean SD p Valuea
Teaching orientation (range = 3 to 15) 11.6 2.3 13.3 1.4 .0004
Engage students (range = 4 to 20) 12.6 3.0 16.5 2.4 < .0001
Support students (range = 4 to 20) 13.2 2.6 15.6 2.2 < .0001
Evaluate students (range = 3 to 15) 7.3 2.6 10.6 2.1 < .0001
Design curricula (range = 3 to 15) 9.5 2.8 12.5 1.6 < .0001
Note. DEI = diversity, equity, and inclusion.
a Dierence in mean ecacy scores tested using paired t test.
Journal of Nursing Education • Vol. 58, No. 11, 2019 639

and skills necessary to achieve such inclusion are needed. One
successful example of such training is the 3-day DEI Institute
described in the current study. Satisfaction and impact of the
DEI Institute was overwhelmingly positive among faculty and
resulted in improved DEI self-efficacy at the conclusion of the
3-day training. Ongoing support and training opportunities are
needed for faculty to continue to incorporate DEI into their cur-
riculum and address challenging topics such as racism when
they arise in the classroom. We hope the DEI Institute can serve
as an example that can be modified by other SONs and areas of
higher education to fit school-specific needs in an effort to make
learning environments more inclusive for all students.
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640 Copyright © SLACK Incorporated

Table A
DEI Self-Efficacy Among Attendees Pre- and Postparticipation in the DEI Institute
Preparticipation
(N = 43)
Postparticipation
(N = 33) p
Valuea
Question N %b
Mean
Score (1 =
Not at All
Confident,
5 = Very
Confident)
N %b
Mean
Score (1 =
Not at All
Confident,
5 = Very
Confident)
1. I can communicate
personal investment in
students and DEI
content.
3.70
4.39
.02
Strongly disagree 1 3.1 0 0
Disagree 2 6.3 0 0
Neutral 9 28.1 0 0
A
gree 15 46.9 19 59.4
Strongly agree 5 15.6 13 40.6
2. I can promote
student participation in
DEI content.
3.23
4.18
<
.0001
Strongly disagree 0 0 0 0
Disagree 9 28.1 0 0
Neutral 11 34.4 2 6.3
A
gree 11 34.4 22 68.8
Strongly agree 1 3.1 8 25
3. I can promote
positive climate for DEI
content.
3.65
4.16
.03
Strongly disagree 0 0 0 0
Disagree 4 12.5 1 3.2
Neutral 9 28.1 1 3.2
A
gree 16 50 21 67.7
Strongly agree 3 9.4 8 25.8
Missing 0 1
4. I can encourage
student questions re:
DEI content.
3.33
4.09
.05
Strongly disagree 1 3.1 0 0
Disagree 6 18.8 1 3.1
Neutral 11 34.4 6 18.8
A
gree 12 37.5 15 46.9
Strongly agree 2 6.3 10 31.3
5. My students are
active receivers of DEI
content.
3.81
4.33
.27
Strongly disagree 0 0 0 0
Disagree 2 6.3 0 0

Neutral 9 28.1 3 9.4
A
gree 14 43.8 15 46.9
Strongly agree 7 21.9 14 43.8
6. I can promote a
positive learning
attitude among
students for DEI
content.
3.59
4.15
.36
Strongly disagree 1 3.2 0 0
Disagree 5 16.1 1 3.1
Neutral 5 16.1 4 12.5
A
gree 17 54.8 17 53.1
Strongly agree 3 9.7 10 31.3
Missing 1 0
7. I can encourage
students to interact with
each other re: DEI
content.
3.09
4.00
<
.0001
Strongly disagree 1 3.1 0 0
Disagree 7 21.9 2 6.3
Neutral 17 53.1 5 15.6
A
gree 6 18.8 17 53.1
Strongly agree 1 3.1 8 25
8. I can actively engage
my students in learning
activities related to DEI
content.
3.24
4.24
<
.0001
Strongly disagree 1 3.1 0 0
Disagree 6 18.8 0 0
Neutral 14 43.8 4 12.5
A
gree 7 21.9 17 53.1
Strongly agree 4 12.5 11 34.4
9. I can provide
support/encouragement
to students who are
having difficulty
learning DEI content.
3.14
3.88
.004
Strongly disagree 1 3.1 0 0
Disagree 7 21.9 2 6.3
Neutral 14 43.8 6 18.8
A
gree 7 21.9 18 56.3
Strongly agree 3 9.4 6 18.8
10. I can let students
take initiative for their
own learning related to
DEI content.
2.91
3.45
.09
Strongly disagree 2 6.3 2 6.3
Disagree 8 25 1 3.1
Neutral 15 46.9 12 37.5

A
gree 7 21.9 15 46.9
Strongly agree 0 0 2 6.3
11. I can show my
students respect
through my actions
related to DEI.
4.05
4.45
.84
Strongly disagree 1 3.1 0 0
Disagree 1 3.1 0 0
Neutral 4 12.5 2 6.3
A
gree 15 46.9 14 43.8
Strongly agree 11 34.4 16 50
12. I can accurately
evaluate my students’
academic capabilities
related to DEI content.
2.67
3.58
.002
Strongly disagree 3 9.4 0 0
Disagree 14 43.8 2 6.3
Neutral 9 28.1 12 37.5
A
gree 6 18.8 16 50
Strongly agree 0 0 2 6.3
13. I can provide
students with detailed
feedback about their
academic progress
related to DEI content.
2.60
3.48
.004
Strongly disagree 5 15.6 0 0
Disagree 13 40.6 4 12.5
Neutral 9 28.1 12 37.5
A
gree 4 12.5 13 40.6
Strongly agree 1 3.1 3 9.4
14. I can approximately
grade my students’
exams/assignments
related to DEI content.
2.70
3.66
.006
Strongly disagree 5 15.6 0 0
Disagree 11 34.4 3 9.7
Neutral 9 28.1 10 32.3
A
gree 6 18.8 14 45.2
Strongly agree 1 3.1 4 12.9
15. I can clearly identify
course objectives
related to DEI content.
3.21
4.24
.001
Strongly disagree 1 3.1 0 0
Disagree 9 28.1 0 0
Neutral 10 31.3 4 12.5
A
gree 8 25 17 53.1
Strongly agree 4 12.5 11 34.4

16. I can prepare
teaching materials
related to DEI content.
3.05
4.18
<
.0001
Strongly disagree 2 6.5 0 0
Disagree 10 32.3 0 0
Neutral 9 29 4 12.5
A
gree 7 22.6 18 56.3
Strongly agree 3 9.7 10 31.3
Missing 1 0
17. I can stay current in
my knowledge related
to DEI content.
3.33
4.15
.01
Strongly disagree 1 3.1 0 0
Disagree 6 18.8 1 3.1
Neutral 11 34.4 4 12.5
A
gree 10 31.3 17 53.1
Strongly agree 4 12.5 10 31.3
Note. DEI = diversity, equity, and inclusion.
a Kolmogorov–Smirnov test for equality of distributions.
b Percent totals may not sum 100 due to rounding.