Equality matters
Written by Maura Oprisko
False beliefs such as “blacks’ nerve endings are less sensitive than whites’,” and “blacks’ skin is thicker than whites’” have been shown to lead to undertreatment of black patients for pain.
Unfortunately, such bias persists. A 2015 study found that 50% of surveyed medical students and residents subscribe to these beliefs, among others.
Kristen Kirby, clinical associate professor of nursing at Purdue, is working to combat biases and inequity in health care and improve the quality of care and treatment for diverse populations.
Kirby, a three-time Outstanding Teacher Award winner (2012, 2013, 2014) and winner of the Sigma Theta Tau Excellence in Education for the School of Nursing award (2017), earned her Doctorate of Nursing Practice (DNP) from Rush University in August 2019. She has dedicated her doctoral project to an overhaul of the School of Nursing’s diversity training in a three-pillared approach: curricular assessment, faculty assessment and development, and student assessment and development.
Channeling privilege into necessary change
Kirby’s identity as a straight, white woman gave her pause.
“I felt like maybe I wasn’t the best person to handle that topic,” she says. “But on the other hand, I recognize that I do have more privilege than others, so maybe I can use that to advocate for those who are underrepresented, or identify with diverse groups that don’t have a lot of support.” Kirby adds that her concept of what diversity looks like has grown. “Diversity can include political differences, religious differences, socioeconomic backgrounds and so on. It’s more than race.”
To combat the pervasive nature of bias, she set out to infuse the current curriculum in the School of Nursing with a more organized, systematic approach to diversity and inclusion education.
“What literature shows is that diversity training doesn’t work as well in an isolated class as when you infuse it throughout the entire curriculum,” Kirby says. “Not only does it say to the students that this is important in everything you do, but it shows the students themselves that we’re advocating for them and we’re advocating for their patients.”
Mary Ajuwon, a continuing lecturer at the School of Nursing, agrees. Ajuwon indicates how important Kirby’s project is, because change starts with nursing students — who may even find themselves disadvantaged by a lack of awareness and inclusion.
“This is a huge issue,” she says. “It’s huge and it’s not a maybe. It affects even international students and their performance; they might not understand what we’re doing in class.”
A progressively designed diversity curriculum, she says, is something needed at any level of education because it benefits people at all walks of life.
Janelle Smalls, a continuing lecturer who specializes in public health nursing, affirms Kirby’s assessment that in addition to racial disparities, one factor leading to poor patient health outcomes is a minimal exposure to LGBT populations. In fact, she’s made her own efforts to increase students’ awareness in her classroom.
Smalls recently facilitated a class discussion based on literature reviews indicating that negative attitudes toward LGBT patients can be blamed, at least partly, on a lack of interaction with this population and limited LGBT-specific care covered in curriculum.
“I believe there are knowledge gaps in nursing as it relates to providing appropriate care to the vulnerable, the underserved, persons with various disabilities and LGBT populations,” she says.
A systematic, measurable approach
In the 2018 fall semester, Kirby established an intervention group in a senior-level course, NUR 41001, and added 20 hours of diversity and inclusion content.
“This has to be a faculty-led change, and I am fortunate to work alongside amazing, supportive and innovative colleagues who advocate for patients and students by preparing future nurses to provide safe, holistic, quality care. The results of this change will be ours, not mine.”
Kristen Kirby
Clinical Associate Professor of Nursing
The added content included a massive open online course (MOOC). The MOOC, which wass developed by Dr. Charles Calahan, assistant director of Global Learning Development, allowed students to interact with people from all over the world. Additionally, students took the Harvard Implicit Bias tests, participated in Assessment Technology Institute (ATI) Civility Mentor Simulations and completed hours of experiential learning. Before the course, Kirby assessed the students in cultural competency to establish a baseline, and again at the end of the course to monitor their progress. The 2019 spring semester of NUR 41001 served as Kirby’s control group and she anticipates comparing the two groups in May.
On a larger scale, Kirby is monitoring a cohort through diversity training from the very beginning of their BSN degrees all the way to graduation.
To date, there’s no literature where something this comprehensive has been done,” she says. “Typically, it’s limited to a course, study abroad or a specific activity within a course."
Pam Karagory, interim head of the School of Nursing and Kirby’s project facilitator, is excited about Kirby’s findings.
“Kristen’s project resonated with me, because it will have a direct impact on the quality and relevance of our nursing curriculum in preparing future nurses who will support diversity, inclusion and equity in the provision of health care,” she says. “Her preliminary data from the fall semester in the senior class was remarkable in terms of how much the students’ understanding of diversity and inclusion has increased as a result of Kristin’s curricular work.”
Kirby is not ready to announce the results at this stage, but she is optimistic she is on the right track.
“I will say that the data is currently demonstrating that when students have intentional and standardized diversity and inclusion education, their individual and group assessment scores indicate a statistically significant increase,” she says.
Karagory and Kirby hope to explore the development of a 1- to 2-credit-hour course as a supplement to the expanded diversity content. The required course would include more experiential learning.
“My goal would be to have the students look at diversity from a very broad perspective,” she says. “I’d have students go spend time in the cultural centers on campus, and maybe work a semester in a cultural center. Or go work at the food pantry or homeless shelter. And I want them to look at how this affects their knowledge, attitudes and skills from a nursing perspective — nursing occurs everywhere.”
Kirby is thankful for an overwhelmingly positive response and participation in the project.
“I had all these faculty members saying, ‘I want to do that with you; can I be a part of the team?” Kirby says. “This has to be a faculty-led change, and I am fortunate to work alongside amazing, supportive and innovative colleagues who advocate for patients and students by preparing future nurses to provide safe, holistic, quality care. The results of this change will be ours, not mine.”
