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Cultural Incongruence in Nursing Education

Ong-Flaherty, Chenit DNP, RN, APHN-BC, CNL

AJN, American Journal of Nursing: November 2016 - Volume 116 - Issue 11 - p 11
doi: 10.1097/01.NAJ.0000505561.80881.fa

A gentle argument for trying harder to see through others’ perspectives.

Chenit Ong-Flaherty is an assistant professor of nursing in the School of Nursing and Health Professions at the University of San Francisco. Contact author: The author has disclosed no potential conflicts of interest, financial or otherwise.



I recently participated in a university-wide discussion with other faculty and university leaders on the importance of diversity among our students and faculty. Although the discussion centered on ethnic and gender diversity, we know that cultures can be defined in many other ways—socioeconomically, for example, and by geography, age, and gender categories outside the male–female binary. The lack of a broader perspective can leave many people out of an effective discussion.

Cultural incongruence occurs when there is a lack of cultural similarities or understanding between people in a relationship. There is much literature on culturally incongruent care and patient outcomes as well as on how cultural incongruence affects health care education, which in turn affects patient care. We know that patients often do less well when they feel judged or misunderstood by providers who are unaware of their particular culture. This type of treatment also takes an emotional toll when it occurs in education. Faculty who do not understand the backgrounds of students may judge them for not sharing the customs, beliefs, and values of the dominant culture or cultures.

As part of my efforts to promote cultural awareness, I conduct a critical cultural awareness exercise for nursing students. The exercise has worked as an informal door opener. After the training, many students share with me their stories and experiences as a minority. They often feel judged and alienated. For example, a faculty member evaluated a student who was a refugee from Asia, noting that because the student was “too polite” she wasn't a “go-getter.” The student was dejected that the faculty member made an assumption without knowing her story of surviving conflict and the challenges of being a refugee.

Another student, who came from a financially challenged background, had to work to support her siblings. Even though she was doing well in all her courses and would later graduate with honors, she was told she was opting not to take her studies seriously. This negative attitude toward students who work may be grounded in a perspective of socioeconomic privilege, one that assumes the decision to work is made because of misplaced priorities and not out of necessity.

I lived through a similar experience. More than 30 years ago, I found myself attending a small respected liberal arts college on a full scholarship. My four years were filled with memories of students and faculty who made fun of what I wore, my lack of “proper English,” the strange foods I preferred, and my ignorance of upper-class cultural norms. Through many tears, I persisted because the education was important to me. With the support of a handful of friends and faculty, I learned to forgive the ignorance of others.

This is the same advice I give my students today. Put on a Teflon coating and trust that you are doing the best you can without apologizing for your different reality. Find support and stay humble—the time may come when you will nurture the next generation of students. As a faculty member, I still take my own advice to heart. The sense of alienation persists when I hear judgmental comments, whether the cultural incongruence is based on ethnic, socioeconomic, or other differences. I appreciate that the comments may be made without ill intent, but the insensitivity is still painful to experience.

As our society becomes more diverse, we owe it to our students and our patients to hold ourselves, as educators and nurses, to a higher standard—to make the effort to remove our blinders of cultural dominance and difference. One way to do this is to challenge ourselves to go to places that make us uncomfortable physically and emotionally, such as to an underdeveloped country or an underresourced neighborhood. We can reflect on the experience of being the outsider and nurture our humility, tempering the propensity to judge. Developing an awareness of who we are in relation to those we work with is the first step to becoming culturally sensitive. Only when outsiders feel included will our discussions on diversity be meaningful.

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