Teaching the Meaning of Culture in a Baccalaureate Nursing Curriculum

CULTURAL SELF-ASSESSMENT

Our university’s Bachelor of Science in Nursing (BSN) program highlights culture and its infinite considerations in the BSN philosophy, curriculum, assignments, care plans, and evaluations. One of the first assignments is a cultural self-assessment that all students complete based on select demographics and Leininger’s (1978) original domains (see Figure 1). When completed properly, this holistic, interrelated mind–body–spirit assignment facilitates the realization of culture’s impact on each student’s own life, sometimes for the first time. Because most of the students are adolescents or young adults, they may not yet have been exposed to the transience of life and the reality that their loved ones may not always be around. Thus, a serendipitous outcome of this assignment is the students’ recognition of the rich cultural ancestry in their own lives.

Figure 1.

Cultural Self-Assessment and Analysis Guidelines.

This cultural self-assessment encourages the students to interact with and learn from their older family members. The students are encouraged to take the time to visit their relatives, listen to family stories, study pictures, collect or prepare recipes, and so forth, so they can learn the cultural significance of each. The intended professional outcomes of this assignment are to personally acknowledge the multifaceted ramifications of culture in the students’ own lives and to develop cultural competence that will ultimately help them to serve as client advocates and to provide culturally congruent, holistic care.

Prior to the introduction of the cultural self-assessment, the students’ own unique cultures are introduced as the nurturing mind–body–spirit environment in which they were raised, a dynamic process that influences their beliefs, and the lens that brings their reality into focus. Even without consciously thinking about it, the students have become manifestations of their own unique cultures, influenced by the people around them but ultimately choosing what fits best into their lives.

HOW CULTURE IS INTEGRATED INTO THE NURSING CURRICULUM

Prelicensure BSN students are first introduced to cultural self-assessment in their prerequisite Wellness course that is actually a self-discovery course; RN-to-BSN students are introduced to it in a Mobility course. From the inception of our BSN program, our faculty believed that students should know themselves before learning about others, including future clients. To that end, this course was designed to present various common concepts; though students were familiar with most of the concepts, they had rarely been asked to reflect on how these concepts pertained to their own lives, and their self-discovery was often noteworthy. Perhaps the most striking realization for many students was the multifaceted aspects of culture, and how those aspects are intricately integrated throughout the students’ lives in unique, unanticipated ways.

The cultural self-assessment assignment includes select demographics and Leininger’s (1978) adapted domains, on which the students must elaborate. In addition, students submit at least one photo of themselves, and this particular inclusion has become a favorite, with students submitting photos not just of themselves but also of their special occasions and loved ones. One faculty member has her students prepare a collage of favorite photos. Overall, students describe this cultural assignment as an enjoyable experience. Not only do they learn more about themselves and their peers, but this cultural sharing offers potential long-term appreciation of life’s precious connections that should be savored and honored. That awareness and appreciation can enhance their future culturally congruent client care.

DEMOGRAPHICS

Though students have often filled out forms with their own demographic information, they may never have considered the cultural nature of this information. In this portion of the cultural self-assessment, students are asked to ponder each piece of information for its cultural relevance, positive or negative. By so doing, the BSN faculty hope that students will also consider the cultural meaning of their future clients’/patients’ demographic information.

CULTURAL DOMAINS

Leininger’s (1978) original domains were slightly modified to provide a framework for this cultural assignment (see Figure 1). Her adapted domains serve as guidelines that are presented as a holistic, interrelated inventory of cultural prompts. Students can redistribute or reiterate content as they see fit, as long as all requested content is provided in the completed document. This flexibility facilitates incorporation of pertinent cultural data into a cohesive, logical, and meaningful document. If students’ cultural beliefs, customs, or behaviors stray from those of their family, they are encouraged to cite their family’s views and then describe how and why theirs are different.

Though not specifically listed within any one domain, students are asked to include typical and special-occasion foods and to describe cultural celebrations, such as holidays, anniversaries, birthdays, rites of passage, and other events. Students are also asked with whom they celebrate these special events. Foods and celebrations are expressions of love, comfort, happiness, joy, traditions, customs, rites, and rituals, so a cultural assessment is incomplete without the inclusion of foods and celebrations.

During class and in small lab groups, potential responses to these domains are openly discussed, with students often seeking clarification, volunteering cultural information, or exploring potential examples. These open discussions provide invaluable cultural learning experiences as students not only share their information but also learn from each other. They find connections and bridges where before they may have only seen walls, and they bond with peers who were previously strangers, possibly recognizing that everybody offers potential connections, including classmates, clients, and coworkers.

CULTURAL CELEBRATIONS

As part of this curriculum, festive cultural celebrations are held in each Wellness lab. Students bring meaningful cultural artifacts, such as family photo albums, music, recipes, memorabilia, and favorite foods and/or beverages. Students explain the cultural significance of these items to their peers, and literally partake of each other’s cultures in an enjoyable—and tasty—fashion. During the cultural celebrations, similarities between and among cultures are identified, and these serve to unite the students, highlighting the fact that we are all, indeed, connected. Nonetheless, while they are encouraged to appreciate the similarities, they are repeatedly reminded to honor the manifestations of their own multicultural uniqueness that they have honed from their many cultural influences. They are urged to continue their cultural self-awareness, enhance their own dynamic cultural expressions, and be proud of their multicultural nature, because their culture has contributed to their uniqueness.

SUMMARY

Our BSN Program emphasizes culture and its myriad considerations. Students expressed positive feedback regarding the integration of culture into our nursing program:

The BSN faculty believe that students who are culturally self-aware are better prepared to honor each future client’s unique culture, ask how the client’s cultural health needs can be facilitated, and address those needs. While students can never know everything there is to know about all cultures, they can be aware that each person has unique cultural considerations that should be addressed, especially about health and health care. By building cultural bridges, our BSN students will become safe, holistic (mind–body–spirit), culturally competent client advocates to help people maximize their wellness across the lifespan.