San José State University School of Nursing in San José, Calif., is a state-funded program with a significantly multicultural student body. In 1988, our student population was 75% Caucasian and 25% racial and ethnic minorities. Today, however, thanks to intensive multicultural outreach recruiting designed to better reflect the demographics of the region we serve, those numbers have reversed dramatically: 75% of our students are persons of color, primarily from Vietnamese, Filipino, Hispanic and African-American backgrounds.
But even at a multicultural campus where “minority” students are the majority, many students of color face special challenges in successfully navigating their way to graduation and transitioning into a professional nursing career. Based on more than 12 years of experience mentoring multicultural nursing students, I have found there are two primary areas of need: emotional support and improving interpersonal communication skills. San José State’s School of Nursing Mentor Program has developed effective strategies for assisting students in both of these critical areas.
Students of color often experience feelings of isolation and loneliness during their enrollment in the nursing program. In some cases, this is because the student is the first person in his or her family to attend a university and no family members can share this experience or offer advice. Many of these students feel that while their families are supportive, they don’t understand the stresses that the students are encountering.
To meet this need for emotional support, our mentor program offers students three options:
Professional nurse mentors
Our nursing students of color have found that being matched with a professional mentor, either from their same ethnic background or not, is very beneficial. While the degree of involvement between student and mentor varies in different mentoring relationships, all of these pairings have provided the students with enormous support.
Students report feeling very comfortable with their mentors, who can often relate personally to the students’ experience and have shared the same frustrations and challenges. The opportunity to work closely with a nursing professional also gives the students exposure to successful role models, the realities of nursing practice and the different career choices available to them.
This option pairs students with other students of color in the nursing program. Students in the advanced levels of the program provide mentoring support to peers in the beginning levels, serving as “big brothers” or “big sisters” to their mentees.
In this program, School of Nursing faculty act as mentors to provide students of color with both emotional and informational support. From their unique vantage point, faculty members are aware of university services students may need. For example, Counseling Services can not only provide assistance with personal and family problems but can also help students with test-taking strategies, study skills, relaxation techniques and overcoming math anxiety.
Learning to Talk the Talk
The School of Nursing Mentor Program also focuses on assisting students of color who have significant problems in communicating effectively with faculty members, medical staff and patients.Because of their cultural backgrounds, many of these students view authority figures, including faculty and nursing staff, as busy individuals who don’t have the time or patience to talk with students. The lack of culturally diverse faculty role models is also problematic, further contributing to many minority students’ discomfort about approaching their professors when they need help.
Students have also reported problems with comprehending faculty members who talk too fast and with feeling guilty when asking questions about concepts they don’t understand.
As part of the mentoring process, we encourage the students to write down questions or tape-record conversations with faculty members. This approach is effective because students don’t feel guilty about taking up faculty’s time and they can review the answers at their own pace. I also encourage them to bring a friend along when meeting with a professor, as this is less frightening than facing the faculty member alone.
Role-playing is another highly effective strategy I use to help students of color feel more comfortable in stressful interpersonal situations. I assist them in preparing a “script” to follow and we practice the script with me playing the authority role, giving various types of responses to what the students say.
This plan is also helpful in the clinical setting, letting the students strengthen their skills in interacting with supervisors, coworkers and patients. Through role-playing, they practice assertive behavior and dialogue that will facilitate direct communi-cation among members of the health care team.
The nursing profession values nurses who are client advocates and who act assertively on behalf of their patients. For some students of color, such as those from Asian backgrounds where it is considered disrespectful to question authority, such displays of assertive behavior may be in direct conflict with the student’s cultural beliefs.
This contrast between behavior that is expected in the clinical setting and acceptable behavior at home can cause students to feel emotional distress. Here, too, I use role-playing to model appropriate clinical behaviors and help students develop the assertiveness skills they will need to succeed in the workplace.
Cultural miscommunication between faculty and minority students is another common problem. An example of this occurred when a professor referred a student to my office because the student had not prepared properly for her clinical and was therefore considered unsafe in the clinical setting. Talking with the student revealed that she had researched the patient’s disease process and had read the required sections of the textbook, but had not understood the material.
When the student was quizzed in the clinical setting, she told the professor that she had not done the appropriate readings, when what she really meant was that she didn’t understand what she had read. I was able to help this student by explaining the difference between these two concepts.
Some nursing students of color, especially those for whom English is a second language, will answer “yes” when asked if they understand lecture content or clinical instructions, when in fact they do not entirely understand the material. This behavior is the result of anxiety, embarrassment and the need for approval from an authority figure. A more effective method of evaluating these students’ comprehension is to have them explain the content or procedure in their own words.
Building Clinical Confidence
In the clinical setting, too, many beginning-level students of color may be anxious, self-conscious and unsure of their communication skills. Some students may respond with culturally accepted but inappropriate responses. They may also feel uncomfortable when providing care for Caucasian patients and find it very stressful to interact personally with them.
Once again, role-playing exercises are an excellent way to increase students’ comfort levels in these situations and help them develop confidence in themselves. I demonstrate examples of the types of conversations and behaviors that are acceptable when caring for patients, and then the students practice the art of conversation or “small talk” with each other.
In addition, placing minority nursing students in clinical settings that serve multicultural populations can greatly benefit both the students and their patients. Our mentoring program has found that initial clinical assignments in this culturally familiar setting decrease the students’ anxiety, because they understand the culturally influenced behavior of their patients.
Moreover, multicultural patients may feel more comfortable discussing health care issues with a student nurse from the same ethnic background. This shared understanding of cultural traditions and beliefs can aid in effectively changing patients’ health-related behaviors and compliance with medical treatments.
The goal of mentoring students of color is to empower them. When students feel empowered, they can overcome obstacles, graduate from a nursing program and begin to make immeasurable contributions to providing quality health care in a culturally diverse community.
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