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This article discusses the personal and professional journey of discovery experienced by a nurse lecturer as a result of engagement in a project exploring the impact of racism in the nursing classroom. The findings of the study demonstrated the existence and complexity of racism, the impact of racism on student learning, the limitations of lecturers in recognizing and addressing racism and organizational factors which perpetuate institutional racism. The authors describe the insight gained from the research process and how this has influenced the practice of the first author and how reflection and mentorship by the second author have challenged personal ethnocentricity, encouraged new ways of thinking, enhanced confidence and encouraged experiential teaching strategies. The article highlights the ways in which nurse lecturers might become culturally competent and in particular addressing issues of racism in the classroom and enabling learning which is applicable in practice.
Racism in nursing education:
a reflective journey
here is consistent evidence of the
need to improve the cultural com-
petence of nurses and address racism
in healthcare in the United King-
dom (UK) (Papadopoulos et al, 1995, 1998;
Gerrish et al, 1996). Racism is neglected in
nursing curricula despite the responsibility
of education providers to prepare culturally
competent practitioners (Narayanasamy and
White, 2005). This presupposes particular
curriculum content, but also demands that
lecturers have knowledge and skills which
facilitate culturally sensitive learning in the
This article reports on a study of classroom
racism experienced by nursing students
and lecturers, and the ability of lecturers to
confront prejudice and deal with insensitivity
(Tilki et al, 2006). The impetus for the project
was intolerance and prejudice observed in
the classroom, concerns about its impact on
learning and the implications for clinical
global terrorism, endemic Islamophobia and
recent debates about multiculturalism all
impact on the relationship between nurses
and their patients. Literature suggests that if
nursing curricula are to prepare culturally
competent nurses they must encompass
cultural awareness, cultural sensitivity
(Burnard, 2005; Sargent et al, 2005) and
ensure anti-discriminatory/anti-racist
practice are addressed adequately (Nairn et
al, 2004; Cortis and Law, 2005).
The Race Relations Amendment Act (2000)
requires public authorities to tackle all forms
of racism. Yet racism within nursing curricula
and anti-racist education are largely neglected
in the preparation of nurses for practice (Cortis
and Law, 2005; Sargent et al, 2005). Foolchand
(2000) and Nairn et al (2004) argue that
explicit anti-racist measures are urgently
needed in nursing education. Narayanasamy
and White (2005) highlight the need for
professional development for nurse educators in
anti-racist and cultural competence education.
Since multiethnic cohorts are the norm in many
universities, the ‘whiteness’ of institutions must
be challenged (Husband, 2000; Purwar, 2001)
and Anglo/Eurocentric values embedded
in organizational cultures questioned (Allan
et al, 2004).
While there are many critics of the concept
of cultural competence (Culley, 2001;
Chenowethm et al, 2006), nursing literature
highlights a variety of strategies for preparing
culturally competent practitioners. Some argue
that the most effective way to equip nurses with
cultural knowledge, skills and competence is a
designated course or module (Lockhart and
Resick, 1997; Braithwaite et al, 2006). Others
suggest immersion or intensive experience
in another cultural setting (Wimpenny et
al, 2005). Sargent et al (2005) propose a
spiral curriculum, integrating transcultural
issues across programmes. Several models exist
to underpin and inform the development
of transcultural/cultural competence skills
(Papadopoulos et al, 1998; Narayanasamy,
2002). All these approaches have merits and
limitations but highlight the complexity of
transcultural education in pre-registration
This article discusses the personal and professional journey of discovery
experienced by a nurse lecturer as a result of engagement in a project exploring
the impact of racism in the nursing classroom. The findings of the study
demonstrated the existence and complexity of racism, the impact of racism on
student learning, the limitations of lecturers in recognizing and addressing racism
and organizational factors which perpetuate institutional racism. The authors
describe the insight gained from the research process and how this has influenced
the practice of the first author and how reflection and mentorship by the second
author have challenged personal ethnocentricity, encouraged new ways of thinking,
enhanced confidence and encouraged experiential teaching strategies. The article
highlights the ways in which nurse lecturers might become culturally competent
and in particular addressing issues of racism in the classroom and enabling
learning which is applicable in practice.
Key words: Racism n Research n Reflective Practice n Education
Kathleen Markey is Senior Lecturer and Mary Tilki
is Principal Lecturer, School of Health and Social
Sciences, Middlesex University, Middlesex
Accepted for publication: January 2007
practice. The findings mirror other publications
(Sawley, 2001; Nairn et al, 2004; Cortis and
Law, 2005) but provide new insights into an
under-researched area.
This article discusses the personal,
professional journey of discovery experienced
by one nurse lecturer (KM), through her
engagement in research. The opportunity
to critically reflect with an experienced
transcultural researcher (MT), and deliberate
on and explore the findings, led to changes
in teaching, an enhanced knowledge and
confidence and a commitment to ongoing
Literature review
Although cultural competence is a complex
and contested notion, it is widely regarded
as an essential attribute in nursing graduates
and is a core requisite for nurse education
(Canales and Bowers, 2001). Wimpenny et al
(2005) highlight that learning about culture
in the classroom is central to personal and
professional development, which is then
mirrored in clinical practice. However,
the development of culturally competent
practitioners continues to present a challenge
for nurse educators. Nursing does not occur
in a vacuum. Contemporary concerns about
Kathleen Markey, Mary Tilki
British Journal of Nursing, 2007, Vol 16, No 7
learning while Papadopoulos et al (1998)
and Burnard (2005) emphasize the critical
reflection needed to analyse personal and
professional ethnocentricity. Cortis and
Law (2005) highlight the lecturer as a role
model while Mezirow (1990) focuses on risk
taking and critical reflection as important
elements of transformative learning. Lecturers
need encouragement and guidance to adopt
culturally sensitive teaching strategies which
may be uncomfortable for them and resisted
by students.
A personal and professional
At the start of this project, although not
complacent, I believed I had insight into
transcultural education issues and knew what
constituted racism. However, working with a
team reviewing literature, developing research
tools, collecting data, analysing findings and
writing a research report helped me realize
how superficial my insight was. Critically
reflecting on my own practice in the light of
literature and project findings has enhanced
my personal and professional development.
In particular, sharing misconceptions,
mistakes and anxieties during team meetings
provided a safe environment to discuss
understandings, feelings and perceptions.
The lead investigator stimulated reflexivity,
exploring feelings and perceptions of the
data, interpreting, questioning and justifying
interpretations and explanations during
analysis. I have tuned into internal processes
which are crucial elements of transformative
education, critically questioning my practice
and encouraging innovative and experiential
strategies when teaching. My reflections
are informed by Kolb’s framework (1984),
although the scope of the article does not
address this.
A painful enlightenment
Engaging in the project has been a positive
but painful enlightenment. The first
uncomfortable reality was the evidence
of racism between students from different
cultural backgrounds, by students against
lecturers and by lecturers against students.
The data have shown me that racism is a
complex and sensitive issue, manifested in
differing ways at individual and organizational
level. I now realize it is not confined to the
discriminatory attitudes or behaviours of
White people against Black people, but
includes Black against White as well as
discrimination between different cultural
groups who share the same skin colour:
and undergraduate nursing programmes. The
shifting, dynamic and contextual nature of
the term ‘culture’ makes it hard to define. The
term ‘cultural competence’ suggests that it is
a technical skill for which practitioners could
be trained and there is a danger that culture
could be explored in isolation and seen as
static (Chenowethm et al, 2006). There is a risk
of focusing on the culture of the client rather
than the dynamic created by the practitioner’s
culture (O’Hagan, 2001). However, these
problems are not insurmountable and the
success of any strategy relies on the abilities
of nurse lecturers to facilitate transcultural
learning (Braithwaite et al, 2006).
Duffy (2001) argues that current
transcultural learning and teaching strategies
do not meet learners’ needs because they fail
to move beyond differentiating the self from
the ‘other’, instead emphasizing the exotic
and generalizing cultural groups. Nurse
lecturers lack skills in teaching or developing
transcultural nursing and particularly in
addressing racism (Papadopoulos et al, 1995).
According to Culley (2001), legislation alone
cannot tackle institutional racism in nursing
because it fails to address underpinning
racist values and attitudes. Unless the ‘hearts
and minds’ dimension of anti-discriminatory
practice is acknowledged, compliance with
legislation is at best superficial. Because
racism is rarely intended, explicit or easily
discernable (Essed, 1991; Cortis and
Law, 2005), lecturers must understand its
complexity and the subtlety with which
it is expressed. Challenging and resolving
racism is difficult (Wieviorka, 1995) and
the psycho-emotional aspects are invariably
underestimated (Lowe, 2006). Fear, guilt and
uncertainty lead lecturers to avoid painful
or threatening issues, but because feelings
and misunderstandings are ignored, conflicts
remain unresolved, solutions are not found
and tensions escalate. Teaching and learning
strategies need to confront these issues
if lecturers are to handle sensitivities and
encourage different ways of thinking.
Although transformative educational
approaches are used in nursing education, the
wider cultural literature suggests their neglect
in relation to cultural competence. Reliance on
descriptive knowledge and didactic approaches
(Duffy, 2001), rather than experiential learning
(Razak, 1999) and eschewal of constructionist
and postmodern philosophies (Dogra, 2004),
fail to promote the critical awareness needed
for new ways of thinking (Mezirow and
associates, 2000). These authors emphasize
the ‘self as a starting point for transformative
‘Just pick anyone who is in the
minority, because if you are in a
group where there is a lot of people
from one cultural background, then
they just gel together, then it will be
the ones who may be on their own
who are going to experience it.
(Caribbean 1st year student)
I was not surprized that lecturers recounted
students’ disrespect for each other and lecturers
in the classroom, but before the project I had
not considered the potential racist undertones
of some actions:
‘Well, like tut-tutting and kissing
their teeth when somebody is
speaking. Laughing at someone’s
accent, only clapping when their
friends present or just generally
looking bored. (African lecturer
I was shocked by the subtle ways in which
racism was expressed and particularly by its
impact on students:
‘It makes me feel isolated … my
opinion isn’t valid, because I’m
Jamaican and maybe I’m not like
her. (Caribbean 3rd year student)
Although saddened, I could empathize with
lecturers who failed to challenge unacceptable
behaviour or offensive, discriminatory
‘A comment was made by a
[Black] student about homo-
sexuality. She said “in my culture
it’s forbidden, it’s disgusting, you
know. End of story”. The lecturer
said “OK, that’s your culture”. I’m
sure if I made that statement I
would have been challenged more.
I do think because she was Black
and because it was her culture
that she was allowed to say that.
(English 3rd year student)
The students’ experiences made me
defensive, at times feeling the need to justify
colleagues’ behaviour. I could empathize
with the following lecturer, rationalizing
actions which might be perceived as racist by
‘I could sometimes, without
realizing it, discriminate in some
way. For example, students who
repeatedly don’t do any work
British Journal of Nursing, 2007, Vol 16, No 7
or who are not interested. It has
nothing to do with their colour
of their skin or where they come
from, but sometimes you might
feel yourself very impatient and
just leave them out of the picture.
(English lecturer interviewee)
However unintentional, thoughtlessness,
ignorance or tight timescales might have at
times desensitized me to learners’ needs:
‘I’m trying to express myself …
so you [lecturer] might give me
that look, “oh please hurry up”.
I’m thinking she is racist. (African
student FG2)
I was embarrassed by student accounts of
unfair treatment and angry with colleagues
whose insensitivity to overseas students was
particularly destructive:
‘She [White student] went on
Monday and was told [by the
lecturer] exactly what to do … so I
went and I explained myself and she
[White lecturer] said I can’t explain
anything, everything is in the book.
(Caribbean 3rd year student)
‘She [lecturer] says if you keep
writing this English, this rubbish,
you won’t fi nish your nursing …
When you come out of the door
you see your tears on you. (African
student FG2)
The study especially highlighted the anxiety
experienced by students for whom English
was a second language and contributed to
perceptions of racism when lecturers were
insensitive or impatient:
‘… You know when I was trying to
say something, she [lecturer] was
doing this (rolls eyes up to heaven and
sighs heavily). So I think our lecturers
should be a bit more understanding.
(African Student FG1)
The student narratives made me aware of
cultural behaviours and communication patterns
which I misunderstood and problematized:
‘Most of us Africans speak at the
top of our voices, we speak loudly.
Most White people talk quietly. So
if you are going to say “can you
soften your voice a bit?” That’s not
me. So, maybe if people can also
understand that. (African 2nd year
I began to understand why students
preferred to stick with colleagues from their
own communities for group work. I had not
appreciated the extent to which students felt
displaced and alienated in unfamiliar and
hostile environments:
‘I want a sense of belonging, at
least she speaks my language, if I
go to Louise, maybe, my English
is not very good, and I will be
more comfortable with her. Maybe
beliefs, things like that so you are
comfortable, especially in this
foreign land. (African student FG2)
Equally I had not considered the extent
to which comfortable groupings were
exclusionary, potentially racist or isolationist:
‘I fi nd it very diffi cult and that
nearly put me off, because every
time I come to class, you sit with
groups, and you can’t join them.
(African student FG2)
Like many colleagues, I was reluctant to
dictate working-groups and although I often
did this, I was anxious about being accused of
racism. I had not appreciated the benefits of
mixed cultural groupings in helping students
trust each other, challenge stereotypes and
develop transcultural understanding:
‘I’m sorry to say I was really scared
of Jamaicans when I fi rst came
to this country … Now I have
mixed with many of them and met
different Jamaicans. I know different
(African student FG1)
I now realize that despite resistance, students
enjoy mixed groups and are enriched by the
‘Socializing with different cultures
is the best part of group work.
I mix with a lot of people from
different cultures, and I fi nd this is
a very good experience because you
learn. (African 1st year student)
I admired and envied colleagues who felt
confident and comfortable to handle resistance or
challenge inappropriate classroom behaviour:
‘I’m always happy to challenge. I
try to probe and analyse. (English
lecturer interviewee)
‘... I’m very infl exible about issues
which relate to disrespect for other
people. (Asian lecturer interviewee)
The feelings articulated by the students have
left me with a greater awareness of classroom
dynamics and my role within them. Like many
colleagues, I rarely felt able to challenge. I
particularly lacked confidence differentiating
inappropriate behaviour from that which
might be racially motivated. Ironically, I was
reluctant to intervene for fear of accusations of
racism. This painful and awkward self-discovery
left me feeling exposed and vulnerable but
passionate to increase my knowledge, insight,
awareness and change my practice.
From reflection to application
The students’ perceptions and experiences of
racism have enabled me to recognize different
actions which may be racist or perceived as
such. My confidence in negotiating the grey
area between unacceptable and potentially racist
behaviour is increasing. I am getting better at
justifying judgements, identifying actions or
attitudes with possible racist undertones and
now explore these as learning opportunities.
I am fairly comfortable to admit what I
don’t know and accept that I don’t need to
know everything. Instead, I appreciate the
wealth of cultural knowledge among students
and am becoming more confident using
cultural/clinical scenarios which facilitate
sharing cultural information and experiences.
Student narratives have made me aware of the
differing expectations of students and lecturers.
Educational strategies facilitating participation,
challenging and critique are new to students
from countries where traditional, didactic and
passive approaches are the norm, so the value of
self-learning and learning from each other must
be emphasized. Although often unpopular and
resisted, I am increasingly encouraging students
to explore ethnocentric ideas and challenge
personal prejudices and assumptions.
Before this project, I believed that discussing
different cultures and especially non-UK cultures
was the starting point for cultural competence. I
now believe that transcultural skills development
begins with the ‘self ’, not the ‘other’, as this may
lead to stereotyping (Foolchand, 2000; Nairn et
al, 2004). Additionally, I recognize the importance
of exploring the heterogeneity of British and
White cultures to address ethnocentric or
stereotypical beliefs held by others. Discussions
with co-researchers and familiarity with the
Papadopoulos, Tilki and Taylor model (1998)
have helped me challenge my ethnocentrism
and feel comfortable encouraging the same
British Journal of Nursing, 2007, Vol 16, No 7
among students. I am acutely conscious that
not challenging unacceptable/racist behaviour
impacts negatively on learning. Mentorship
has allayed my fears of getting things wrong
and made me conscious of the greater dangers
of doing nothing. I have heard how
experienced colleagues address issues, especially
handling the uncertainty involved. I am
motivated to challenge, not just because of
the impact on learning but because of the
applicability of experiential classroom learning
to clinical practice.
I am inspired by Burnard (2005) and
Brathwaite et al (2006) to proactively mix
students from different cultures, providing
realistic, pragmatic opportunities for
experiential learning with focused tasks and
corporate goals. Razak’s (1999) work has
motivated me to persevere despite resistance
and I am increasingly confident mixing
groups to explore sensitive or taboo topics,
debate power issues, consider discrimination,
demythologize stereotypes and generally learn
through working together. These processes
are highly applicable to multi-disciplinary and
multi-ethnic teamwork in clinical settings.
There is an urgent need for greater
investment in helping overseas students to
adapt and become confident using their
English in a supportive environment. I am
keen to learn strategies to help students
develop their spoken English in a safe setting.
I would like to develop exercises which draw
on the experience of non-English speaking
students, relating these to communication
with patients whose English is limited.
I am conscious that the policies and practices
of the wider organization must change if
we are to address the needs of our multi-
ethnic students. I am acutely aware of the
psychological barriers at organizational level
to be overcome before this occurs (Lowe,
2006). I cannot make the necessary changes
alone, but in addition to adapting my teaching,
I can use my new knowledge to challenge
discriminatory systems and procedures.
The qualitative study underpinning this article
did not aim to generalize, but the literature
suggests that similar issues may occur in
other nursing departments. While this is the
account of one lecturer in one institution,
the findings are broadly consistent with
wider literature. Further research is needed to
explore the extent of the problem nationally,
especially identifying what knowledge and
skills lecturers need to be transculturally
competent. Lecturers clearly need to be
culturally aware, knowledgeable and sensitive.
They must use strategies that draw upon
the cultural knowledge and experience of
students, encourage dialogue, debate and
sharing ideas to break down barriers. They
must address, in particular, the nature, origins,
manifestations and impact of racism, and
manage that which occurs in the classroom,
especially the institutional type born out of
ignorance, thoughtlessness or ethnocentricity.
Although not the remit of this article, there
is clearly a need to investigate racism by and
against nursing students in clinical settings.
Continuing professional development
opportunities are needed to enable lecturers to
explore the issue of racism, addressing their
ethnocentricity as a precursor to handling issues
in the classroom. Mentorship or supervision
encourages lecturers to explore concerns around
insensitive or racist attitudes and behaviours and
handling uncomfortable classroom situations.
While greater attention is required for
curriculum issues, guidance is needed to prepare,
develop and refine teaching strategies and group
exercises which tease out cultural issues, explore
tensions and conflicts and manage these in the
classroom. Attention should focus on creating an
environment where critical reflection occurs,
blame is avoided, risk managed and new ideas
developed, tested and evaluated. The significance
of a credible, respected role model cannot be
overstated in modelling respect and self-critique,
questioning and challenging, deconstructing
myths and prejudices and reconstructing new
ways of thinking. These qualities, which can be
learned in the classroom, are highly transferable
to the clinical setting, just as my new found
knowledge and skills are applicable beyond the
classroom in the wider organization.
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I Racism is a complex and sensitive issue,
manifested in differing ways at individual
and organizational level.
n Racism is not always identified,
challenged or dealt with appropriately
because lecturers lack confidence.
n Reflecting on and challenging
ethnocentricity is the start of the lecturer’s
journey to culturally competent teaching.
n A supportive safe environment enables
lecturers to adopt anti-racist teaching
n Mentorship/supervision can help lecturers
develop the transformative learning
approaches which are key to anti-racist
and cultural competence education.
British Journal of Nursing, 2007, Vol 16, No 7
... In particular, new academic staff members were reported to be unaware of the reporting pathways available for these students. Evidence shows that some healthcare lecturers are aware of racism in their classrooms, but many feel challenged and thus avoid addressing it, leading to unresolved conflicts and escalating tension (Markey and Tilki, 2007). ...
... Indeed, some ethnic minority pharmacy students at Trinity thought that most of their lecturers are considerate and open-minded (Koay, 2020). Some academic staff recognise their colleagues exhibit racist behaviours towards students (Koch et al, 2014;Markey and Tilki, 2007), but feel challenged to resolve issues of such complexity as racism is perceived as "rarely intended, explicit or easily discernible" (Markey and Tilki, 2007, p. 391). Nonetheless, such experiences of racial discrimination can lead to students feeling alienated (Nightingale et al., 2022) and deciding not to be employed in healthcare institutions when they qualify as healthcare professionals in the future (Andrews et al., 2005;Rees et al., 2015). ...
Technical Report
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Funded by Trinity Equality Fund 2022, the Faculty of Health Sciences Equality, Diversity and Inclusion (EDI) Group and Immigrant Council of Ireland launched a project entitled ‘Stand Up, Speak Out! Racial Justice in Healthcare Education’. This report articulates the lived experiences of racism in minoritised ethnic healthcare students (MEHSs) and recommends strategies to embed racial justice in healthcare education at Trinity.
... Without active anti-racist curricula, nurse education reinforces white dominance, heteronormativity, and classism (Blanchet Garneau et al., 2018;Walter, 2017;Scammell and Olumide, 2012;Van Herk et al., 2011;Cortis and Law, 2005). Markey and Tilki (2007)'s critical reflexive account of racialised minorities in nurse education confirms the reproduction of oppression and acknowledges the uncomfortable experiences Black and Brown nurses feel. Nevertheless, the main focus remains on how nurse lecturers might become culturally competent to address institutional racismviewed as "born out of ignorance, thoughtlessness or ethnocentricity" (p.393) -rather than critically scrutinising the power structures that support white dominance and whiteness as the norm. ...
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Background: Institutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical scrutiny, and serious discussion. This paper focuses on the racialised experiences of nurses and midwives during their education in UK universities, including their practice placements. It explores the emotional, physical, and psychological impacts of these experiences. Methods: This paper draws on qualitative in-depth interviews with participants from the Nursing Narratives: Racism and the Pandemic project. Of the 45 healthcare workers who participated in the project, 28 participants obtained their primary nursing and midwifery education in UK universities. Interviews with these 28 participants were selected for the analysis reported in this paper. We aimed to employ concepts from Critical Race Theory (CRT) to analyse the interview data in order to deepen our understanding of the racialised experiences of Black and Brown nurses and midwives during their education. Findings: The interviews revealed that the healthcare workers' experiences coalesced around three themes: 1) Racism is an ordinary, everyday experience; 2) Racism is operationalised through power structures; and 3) Racism is maintained through denial and silencing. Experiences often touch on a series of issues, but we have highlighted stories within specific themes to elucidate each theme effectively. The findings underscore the importance of understanding racism as a pandemic that we must challenge in response to a post-pandemic society. Conclusion: The study concludes that the endemic culture of racism in nurse and midwifery education is a fundamental factor that must be recognised and called out. The study argues that universities and health care trusts need to be accountable for preparing all students to challenge racism and provide equitable learning opportunities that cover the objectives to meet the Nursing and Midwifery Council (NMC) requirements to avoid significant experiences of exclusion and intimidation.
... Critical reflection is crucial to the development of competent psychotherapists as it offers opportunities to dialogue about implicit or explicit biases and affective or cognitive reactions that may guide assessment, diagnosis and treatment planning. Engaging in such reflective exercises can yield heightened awareness of personal biases or beliefs as it relates to issues of social justice or diversity (Markey & Tilki, 2007;Jacobs, 2006). ...
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Research demonstrates ongoing health inequities for those from the most marginalized communities. To address these health inequities, medical educators have attempted to incorporate education that targets cultural competence of providers. Over the last decade, increasing evidence has demonstrated limitations to a competency-based approach. In this paper, we outline how utilizing critical reflection strategies in clinical supervision can be a long-term, sustainable approach for addressing health inequities, while improving the existing cultural competency model. We begin by demonstrating how existing ideas of critical reflection can be adopted to enhance learning within supervision by encouraging providers to evaluate and re-evaluate existing beliefs and biases. We then propose how an existing approach to treatment (i.e., Metacognitive Reflection and Insight Therapy) may serve as an example for how to activate critical reflection in supervision using three essential factors. Finally, we propose three clinical implications for providers that may work to dismantle existing healthcare inequities including: an increased comfort in feedback seeking, improved confidence working with diverse populations, and increased insight into how inequities emerge in clinical practice and how best to respond when they do.
... Remaining vigilant for potential cultural misunderstandings and subtle tensions in culturally diverse learning environments is essential. Tilki et al. (2007) and Markey and Tilki (2008) reported that racism in the nursing classroom is evident and often goes unnoticed. More recently, O' Brien et al. (2019) drew attention to the importance of addressing ethnocentric ideologies in the culturally diverse classroom as a means of creating mutually respectful learning environments. ...
The expanding cultural diversity of nursing classrooms provides a fertile learning environment for meaningful intercultural learning that can support cultural competence development. However, navigating culturally diverse learning environments and planning intercultural inclusive learning opportunities is not without its challenges. Facilitating inclusive learning in culturally diverse environments is complex and requires strategic planning and supports at both institutional and classroom levels. Nurse educators have a central role in cultivating intercultural inclusivity. Ensuring cultural diversity is valued, and students' cultural identities and educational backgrounds are respected are important. Culturally responsive teaching is fundamental as culture influences the way students learn. This paper outlines specific strategies for nurse educators to consider when planning culturally responsive teaching as a means of nurturing intercultural inclusiveness. Understanding student learning needs and vulnerabilities, facilitating respectful discussions, challenging assumptions, and encouraging intercultural dialogue, are vital areas for consideration.
... However, racism is often euphemised, denied or neglected in nursing discourse (Culley, 2006), creating a false illusion that racism is not an issue for nursing practice. Although the psycho-emotional aspects associated with exploring racism are invariably underestimated (Markey and Tilki, 2007), unless feelings, misunderstandings and narrow perceptions of racism are explored, it is difficult to find solutions or prevent escalation of tensions. There is a need for a more open and non-judgemental discourse around interpretations of racism and its predisposing factors as a means of combating the growing number of reports. ...
The increased reports of escalation of social inequalities, xenophobic and racist ideologies during the COVID-19 pandemic presents a growing concern. Nurses are not immune to xenophobia and racism, both as perpetrators and as victims. Although COVID-19 brings a new wave of xenophobia and racism, healthcare organisations have been tackling discriminatory and racist practices for decades. However, racist practice quite often goes undetected or unchallenged due to its associated sensitivity and a lack of understanding of its complexity. There is a need for a more open and non-judgemental discourse around interpretations of racism and its predisposing factors as a means of combating the growing reports. This discussion paper proposes a practice-orientated conceptualisation of racism and outlines some particular and sustainable areas for consideration for nurses to use in their daily practice. Developing self-awareness and nurturing the courage, confidence and commitment to challenge self and others is critical for transforming ethnocentric and racist ideologies.
... They asserted that by engaging in this uncomfortable introspection, White nurses would be unfettered by racial fears, race denial, and blindness to White privilege. The act of racism is not always deliberate, unambiguous, or evident because it originates in socialized attitudes and behaviors enacted through systematic and accustomed practices (Markey & Tilki, 2007), and nurses at different levels are unequipped to deal with it. For this reason, Yu (2008) and Ackerman-Barger and ...
Background Race is a barrier and source of inequality affecting ethnic minorities in nursing practice and education. Purpose This integrative review study aimed to determine whether racism and institutionalized racism are explicitly named in the titles and abstracts of peer‐reviewed publications on nursing education, leadership, and the nursing profession, and to explore the depth of discussion of racialized concepts in peer‐reviewed nursing literature. Method Whittemore and Knafl's integrative review approach was used to review 23 studies published in nursing journals published from 2008 to 2020. Findings Four themes were extracted: the context of racism discussions in the literature; consequences of experiences of racism; emotional and physical effects of racism on nurses and students of color; and scholars’ recommendations. Discussion Nursing must start to openly acknowledge the issue of racism within the profession, and to address it by providing safe spaces for authentic dialogue in academic and practice settings.
Background: The reemergence of the Black Lives Matter movement in 2020 reinforced the need for antiracist and decolonizing praxis in all areas, including nursing education, the burden for which has fallen predominantly on visible minorities. To enact the needed change within health care systems and nursing education, White nurses must recognize their privilege and become active participants in the conversations and change. Method: This two-phase qualitative study explored nursing and psychiatric nursing students' experiences of racism and antiracism education at a small western Canadian university. Results: Anonymous qualitative surveys (n = 24) and structured interviews (n = 9) with nursing and psychiatric nursing students highlighted the difficulties and complexities of recognizing racism and a present lack of antiracism praxis in educational and health care settings. Conclusion: Nursing educators must reevaluate structural and behavioral aspects of nursing education to support genuine antiracism praxis. [J Nurs Educ. 2022;61(8):439-446.].
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The COVID-19 pandemic amplified the egregious disproportionate burden of disease based on race, ethnicity, and failure of organizations to address structural racism. This paper describes a journey by members of the National Academies of Practice (NAP) who came together to address diversity, equity, and inclusion (DEI). Through collaborative efforts, a virtual, interactive workshop was designed and delivered at NAP's 2021 Virtual Forum to facilitate discussions about DEI priorities across professions and to initiate a sustainable action plan toward achieving inclusive excellence. Resulting discoveries and reflections led us to the essential question: can we truly become an anti-racist interprofessional healthcare organization?
Background Globally, government and higher education institutions are expected to increase international student numbers. Programme development, marketing international collaboration and management has been the focus of strategy roll out. Aims This study aimed to explore international student experiences while undertaking Master of Science postgraduate education far from home. Methods A qualitative descriptive design was used. Following ethical approval, 11 students studying on a Master of Science Nursing postgraduate programme in one health education institute in Ireland volunteered to participate. Students were of Asian origin and mixed gender and the average age was 27. Data were collected using face-to-face semi-structured interviews and data analysis followed Burnard’s thematic framework. Results The data provide evidence of the complexities and challenges experienced when studying on a Master of Science postgraduate nursing programme. Students described a process of juggling to survive and succeed. Three overarching categories emerged: differing realities, working through, and learning new ways. Conclusions This study adds to international debate regarding structures and processes supporting international nurse education. In meeting ethnic and culturally-diverse student learning needs, consideration of learning and teaching approaches is warranted. For globalisation in nurse education to prosper, investment needs to move from focusing on recruitment towards structures and processes to nurture intercultural learning.
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Objective- To introduce the context of cultural diversity teaching in medical education and to compare the concepts of cultural expertise and cultural sensibility with regard to four characteristics: educational philosophy, educational process, educational contents and outcomes as these are integral to course design and delivery. Method- The methodology uses Weber's ideal types and is briefly described before the comparisons are undertaken. Design- It was designed to capture empirical reality by arriving at the analytical accentuation of certain aspects of society by providing a lens through which that aspect of society can be viewed. Results- Student preference for the expertise model may dissuade educators from trying alternative approaches despite the fact that the lack of any evidence that training to date has met this target. To improve the quality of cultural diversity teaching we must understand how those involved in teaching this issue conceptualise and understand the issues around cultural diversity as this so clearly influences the teaching developed. Conclusion- In an environment, which demands increasing evidence based approaches, it may be time to develop tighter teaching models that have clear conceptual frameworks and can more effectively evaluate whether the teaching delivers what it sets out to do.
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This paper is concerned with the way in which discussions of the health status of people from minority ethnic groups and the delivery of health care to such groups has been constructed, in the nursing literature in particular, within a culturalist framework which has many serious drawbacks. The paper reviews the argument for a 'multicultural' approach to health care and also discusses some of the main implications of this analysis for the education of health professionals. It suggests that health workers and those responsible for the education of such workers, need to reassess learning needs in the light of a critique of the effects of an analysis based on 'cultural pluralism' and 'ethnic sensitivity'. The paper suggests ways in which the nursing curriculum must be broadened to take into account the limitations of a culturalist approach and to debate the interplay of racism and other structures of inequality and their influence on health and on a service delivery.
One of the central ways in which institutional racism is perpetuated is through the designation of the somatic norm. However, although the classed and gendered nature of the somatic norm underlying somataphobic representations of the universal `individual' have been both theoretically and substantially explored, the racial character of this embodied being has received scant attention. This paper introduces race to the wider debates on the embodied nature of the political `individual', before analysing the specific ways in which an institution that is deemed to be at the absolute apex of disembodied, neutral professionalism - the British senior civil service - is naturalised as the domain for white men. The somatic norm underlying the representation of the impartial senior civil service is brought to the fore in this paper by discussing the location of black senior civil servants, whose presence helps us to highlight the synchronic relationship between racialised bodies and elite spaces in the body politic. These `Space Invaders' disturb the racialised nature of these spaces whilst at the same time adhering to the assimilative pressure of the somatic norm. An engagement with the interview accounts of black senior civil servants allows us to grasp some idea of what it is like for them to coexist in a place that is built on a `racial contract' which has demarcated spaces in accordance with racialised corporealities. As matter out of place these `different' bodies generate disorientation, undergo the burden of invisibility and abide by the racialised and classed informal rules of behaviour, particularly those of the legitimate language. All of which problematises the notion of `difference' in organisations as entailing much more than the mere existence of `different' bodies, on the basis of race or gender.
Nurse educators are responsible for developing graduates who are culturally competent care givers and marketable as culturally sensitive coworkers. An undergraduate course in transcultural nursing is described that relies heavily on experiential learning activities and local community resources. Student evaluations reveal both immediate and long-term effects of this course on graduates' clinical practice.
There is a serious problem between CAMHS and black and minority ethnic communities, in particular their lack of access to these services, but this is often denied and/or avoided in the practice of CAMHS professionals. This paper explores the reasons for this. It argues that the inaccessibility/way of functioning of CAMHS, is a defence against its members experiencing persecutory anxiety from engaging with black and minority ethnic people. Whilst avoidance and other defences give some relief to staff, it however damages their confidence and prevents them from realising to the full their capacity for concern and for helpful action. This thesis is illustrated and discussed through examples.
This paper opens by identifying the different historical routes European countries have followed in becoming multi-ethnic, and the consequent very different understandings that underpin contemporary national approaches to managing diversity. A discussion of the politics of equal recognition, and of difference, provides the basis for a critique of liberal universalism and of the discourse of 'tolerance'. A model of transcultural communicative competence is presented. It is argued that the introduction of training in transcultural communication into social work education can too easily slip into an individualistic acquisition of interpersonal skills. Referring back to the earlier discussion of the politics of multiculturalism, it is argued that effective social work requires both individual and institution learning.
In an increasingly competitive global labour market, more countries with nursing shortages are recruiting from abroad. The UK is no exception. However, little research has been conducted into the experiences of racism and discrimination among internationally recruited nurses in the UK. The empirical data in this paper contribute to understanding how immigrant workers from Black and other minority ethnic backgrounds experience working in British health services and provide empirically grounded accounts of individual and institutional racism.A total of 67 internationally recruited nurses (IRNs) participated in 11 focus group interviews which were held at three sites in the UK: Leeds, Cardiff and London. These focus groups were audio-taped and analysed using NVivo, version 1.3. In focus groups, IRNs described discrimination and racism as central to their experiences as IRNs working in the UK. This study demonstrates the ways in which racism and institutional racism work in healthcare practice from the perspective of IRNs and how they cope with these negative experiences. The data suggest that racism and institutional racism are understood in more complex ways than previously reported and that institutional racism may be reproduced through negative stereotypes of foreigners and professional hierarchies which are forms of structured social relations. These structured social relations are reproduced in complex professional relationships and hierarchies, in the meaning of ethnicity and stereotypes for individuals and the relationship between racist attitudes and racist behaviours.Based on these findings, we argue that racism and institutional racism are reproduced through personal and interpersonal as well as structured social relationships, and provide working examples of the concept of institutional racism in practice. We discuss the implications of the findings for equal opportunities policies in the health services.
Aims: To propose a process that will facilitate cultural competence in Australian nursing practice. Background: Cultural diversity is a prominent feature of the Australian health system and is impacting significantly on nursing care quality. A fictitious, but typical clinical exemplar is profiled that identifies cultural insensitivity in care practices leading to poor quality outcomes for the health consumer and her family. Strategies are proposed that will reverse this practice and promote culturally competent nursing care and that locates overseas qualified nurses in this process. Conclusion: This paper contributes to nursing care quality internationally by articulating strategies to achieve cultural competence in practice. Nurses must pay attention to interpersonal relationships and develop respect for the health consumer's value systems and ways of being, in order to protect their rights and avoid the tendency to stereotype individuals from particular cultures. The expertise of qualified nurses from different cultures can greatly assist this process.
Transnational alliances and changing global realities have resulted in a proliferation of material relating to diversity and social work practice. More recently the focus has rested on anti-oppression and multicultural social work. Although there is growing acceptance of the need to be sensitive to diverse populations, the struggle often lies in pedagogical and practice considerations. Courses dealing with oppression have emerged and the emphasis has been to encourage student and teacher to examine their own biases and understand their ethnicity and culture while seeking to develop a framework for sensitive practice. Issues relating to power and subjugation are highlighted along with an understanding of history and present realities. Pedagogical and practice struggles need to be addressed on a consistent basis to ensure that the slippage towards a more didactic approach is not adopted in order to avoid dealing with sensitive material and issues. This article represents a synthesis of my experiences of developing a half credit course on anti-discriminatory practice and teaching it over a period of five terms. The guidelines and approaches used for teaching this course include journals, reflective papers, coalition groups and small group discussions. These approaches are discussed, together with an examination of the location and struggles of staff and students, and ongoing challenges to effect social knowledge production that is premised on an anti-discriminatory and anti-oppressive framework for practice. Excerpts from student journals, my observations, and feedback from student evaluations are utilised to promote a critical reflection of pedagogical and practice concerns necessary for sustaining an anti-oppression framework for social work practice. The ways in which groups, individuals, and ideas come to be marginalized in a given culture, society, and/or place has much to do with what is considered to be knowledge and who is considered to possess it, who is perceived as knower and who is known (Edgerton, 1993, p. 222). Curricula are revised but rarely transformed from the inside out (McGee, 1993, p. 281).