Inspired Toward Nursing: Culturally Responsive Community-Based Learning

Communities develop in many contexts: a circle of friends, a group of coworkers, a class full of students, and a series of Web profiles linked together by virtual friendship are just a few. By connecting with students in the context of their unique environments, educators find their teachings have a greater impact. But what are the key elements for culturally responsive community-based learning? The following case studies examine this concept and its relation to students’ learning outcomes. These instances support and/or create best practices in culturally responsive community-based learning for the University of Saskatchewan College of Nursing in Canada. Here, research shows that participating in community-building activities informs and improves curriculum design, development, and implementation.

The case studies provide a description of strategies, themes, and initiatives that create and support promising practices in culturally responsive education, particularly regarding the promotion of nursing as a potential career. The desired learning outcomes of the culturally responsive community-based interventions includes enhanced cultural and contextual mediated strategies with a community of learners; an assessment of the knowledge, skills, attitudes, or beliefs essential to learning; the incorporation of cultural variations in learning into curriculum and learning strategies; and developing the capacity of communities of learners to plan and manage their own learning.

Literature review

Important changes occur in learning and teaching when educators try to comprehend and respect the diverse worlds of students and include this understanding in their teaching.¹ Faculty who adopt learner-centered, culturally responsive approaches must constantly assess and modify their teaching and learning practices “to choose and adapt content, instructional materials, and evaluation instruments to reflect and respond to the rich and complex diversity of the students they teach.”² Research suggests learning is a contextual process and requires complex interactions among various individuals throughout the educational process.³

Among nursing literature, the concept of cultural responsiveness is described as demonstrating the ability to accept cultural beliefs and values while developing “strategies to improve the cultural competence of future nurses to help them care and intervene effectively with individuals from cultures other than their own.”⁴ Ideally, community-based learning should be rooted in the objectives of the curriculum, integrated through reflective assignments, and designed in conjunction with the community.^5,6

These case studies describe educational initiatives that bring students, decision makers, community members, artists, educators, and researchers together in active processes and interactive engagement.⁷ The students engage in culturally and community-responsive activities, enabling research that informs unique educational outcomes and interventions for diverse age, cultural, and socioeconomic groups.⁸ Findings suggest that active, situated, and social learning communities lead to “a commitment to participatory and dialogic approaches to learning design and facilitation.”⁸ Activities like reflective journaling, independent study, mentorships, and portfolio development all help students plan and manage their own learning outcomes within these communities. A connection also exists between students’ secondary school experiences and university outcomes: involvement in various activities determines what they get out of postsecondary education. ⁹ Learning is enhanced when “there is a commitment to the collective good and people engage in learning through and with others.”¹⁰

Focused on two communities of learners, these case studies examine both a group of nursing students enrolled in a baccalaureate of nursing program (Case Study #1) and Aboriginal high school students from a rural area in the province of Saskatchewan, Canada (Case Study #2). Faculty and students introduced the Aboriginal youth to active, engaged learning strategies and encouraged them to consider nursing as a profession. Research shows a direct link between the Aboriginal students who apply to nursing programs and the Native Access Program to Nursing/Medicine (NAPN/M) described in Case Study #1. Both studies relate to informing practice, connecting learning outcomes and curriculum design, conceptualizing learning, and how the learners themselves inform curriculum development and design.

Case Study #1: Native Access Program to Nursing/Medicine

The Native Access Program to Nursing/Medicine is a support and retention service for Aboriginal nursing students enrolled in the Nursing Education Program of Saskatchewan (NEPS) in Canada. NAPN/M offers advisement for Aboriginal nursing, medical, and pre-health science students dealing with the academic demands of university, access to tribal Elders, culturally appropriate counseling, personal and academic advisement, advocacy (childcare, housing, funding concerns, tutoring, mentorship, and computer and Internet access), and new student orientation. The students and advisors form strong relationships that extend over the four or more years of the health science programs. Statistics indicate that the retention of Aboriginal students in nursing programs has improved steadily since the inception of NAPN/M in the early 1990s.

NAPN/M’s main focus is the recruitment and retention of Aboriginal nursing students; however, when retention is not possible, “successful” attrition becomes the advisors’ goal. When Aboriginal students decide to leave the nursing education program, NAPN/M advisors counsel them toward continuing their education, specifically in another area of health sciences.

The advisors at NAPN/M also help students become thriving members of their communities. Aboriginal nursing students enrolled in academic and cultural programs experience unique teaching and learning strategies that encourage them to honor their traditions and culture. The Aboriginal faculty and staff currently support a critical mass of Aboriginal students (more than 250 in the four years of the nursing program). The Program’s exemplary staff members strive to deliver a program that emphasizes learning outcomes within a culturally responsive context. Aboriginal nursing students are regularly invited to participate in program evaluation and focus groups. Continued success in recruitment and retention will allow NAPN/M to advance toward a more global contribution to inter-professional curricula in addition to its work with the University of Saskatchewan.

Case Study #2: Cultural Visual Arts Initiative

The second case study shows the positive results of fostering a relationship with the youth at Standing Buffalo First Nations community, Saskatchewan, Canada. Researchers observed how youth used photovoice methodology, sharing circles, and cultural guidance from Elders to learn how to “live well” and in keeping with Aboriginal ways. Through these avenues, Aboriginal youth were able to identify, represent, and enhance personal and community assets and potentials for health, which they then captured in visual art. The research partners included the following: a rural, non-treaty Aboriginal community within the Regina Qu’Appelle Health Region in Saskatchewan, Canada; the Nursing Education Program of Saskatchewan; and First Nations University of Canada, the Saskatchewan Institute of Applied Science and Technology, and the University of Saskatchewan.

The project considered the requirements and preferred directions for the development of health care delivery systems and health initiatives that are culturally respectful for Aboriginal people from the perspectives of the youth of the participating Aboriginal community. Over nearly three years of direct involvement, researchers worked with the youth as a targeted learner group. In order to engage and advance the needs and issues related to this unique population, there was a concerted effort to use a wide array of learning and knowledge dissemination strategies to promote learning and wellness. Methods included community newsletters, storytelling, Elders, and sharing circles to understand, share, and co-create knowledge for the participants, health care workers, and others.

The Aboriginal leaders suggested that the research findings be incorporated into a mural messaging health and wellness to the broader community. Team members recognized the unique opportunity to reach a diverse and nontraditional audience for the purpose of advancing health-related knowledge. From the perspective of the Chief, council, Elders, and support staff, this mural catalyzed dialogue and a vision of what their youth needed to achieve or maintain health. This educational translation strategy became a permanent mural (five separate pieces, totaling 26 feet) for the Standing Buffalo powwow grounds, a traditional gathering place where people meet to share, learn, socialize, and honor Aboriginal knowledge and cultural practices. Funding was provided, in part, through the Saskatchewan Arts Board and Canadian Institutes of Health Research Institute of Aboriginal Peoples Health.

As various iterations of the mural circulated through the reservation, its strength as a tool for highlighting knowledge, culture, and social aspects became evident. The community’s respect for the fi nal product refl ected an informed and meaningful arrangement of content provided by the Aboriginal youth. The artist brought both talent and vision to the project and grew in his understanding of art as a medium for health knowledge exchange. Researchers monitored the dialogue and exchange of ideas in real time between both youth and community members regarding what had been learned through the early phases of the research project. Participants recognized the importance of youth finding innovative ways to impact and inform their community, particularly regarding health issues.

The project hoped to provide youth an opportunity to explore their views and values about health, to learn about the power of action, and to make changes at individual, community, and nursing education curricular levels. It is anticipated that this community of learners will approach postsecondary education with a heightened awareness of learning opportunities within nursing and health care. In addition, they worked closely with current Aboriginal nursing students, providing links and inspiration towards their personal career potential. The production of an artistic depiction of the perspective of youth participants clearly messaged their health needs, beliefs, and values. The mural will continue to be displayed in the community as a reminder, tool, and testimony.

Summary

These initiatives were instrumental in supporting culturally responsive learning and curriculum evolution. The research and reflective thinking that has occurred as a result of the initiatives has been used to shift intents within a nursing curriculum. These initiatives support an academic perspective within higher education and enable students to reflect on their own learning with the intent of identifying personal and professional competencies. Culturally responsive community-based learning initiatives should enhance students’ skills, attitudes, and understanding of how to provide better health care to diverse populations in the future. In turn, their feedback will be carefully analyzed to give direction for the current and future curriculum design, development, and implementation. The nursing faculty must have a vision and mission that prepares nursing graduates as citizens of the world.

References

1. Glynn, E., Otrell-Cass, K., and Cowie, B. “Culturally responsive pedagogy: Connecting New Zealand Teachers of Science with Their Mâori Students.” Paper presented September 12 at ECER 2008, Göteborg. (2008).

2. Boles, W. and Kelly, P. “Developing a culturally responsive curriculum: An electrical engineering experience.” [Online]. Retrieved February 14, 2009 from www.ascilite.org.au. (1999).

3. Nygaard, C. and Holtman, C. “The need for learning-centred higher education.” Understanding Learning- Centred Higher Education (11-29). Copenhagen, Denmark: Copenhagen Business School Press. (2008).

4. Cagle, C. “Student understanding of culturally and ethically responsive care: Implications for nursing curricula.” Nursing Education Perspectives. 27(6), 308-315. (2006).

5. Shepard, K. “Higher education for sustainability: Seeking affective learning outcomes.” International Journal of Sustainability in Higher Education. 9(1), 87-98. [Online]. Retrieved November 12, 2008 from Emerald Full Text database. (2008).

6. Strand, K. “Community-based research as pedagogy.” Michigan Journal of Community Service Learning, 7, 85-96. (2000).

7. Lavis, J. N., Robertson, D., Woodside, J. M., Mcleod, C. B., and Abelson, J. (2003). “How can research organizations more effectively transfer research knowledge to decision makers?” Milbank Quarterly, 81(2), 221—248.

8. Levy, P. “A methodological framework for practice-based research in networked learning.” Instructional Sciences. 31, 87-109. (2003).

9. Tam, M. “Assessing quality experience and learning outcomes.” Quality Assurance in Education. 15(1), 61-76. [Online]. Retrieved November 12, 2008 from Emerald Full Text database. (2007).

10. Thompson, T., and MacDonald, C. “Community building, emergent design and expecting the unexpected: Creating a quality of eLearning experience.” The Internet and Higher Education. 8(3), 233-249. [Online]. Retrieved November 12, 2008 from Emerald Full Text database. (2005).