Inclusive Teaching Strategies and Student Outcomes in 4th-Year Baccalaureate Nursing Students: A Mixed Methods Study

Purpose: Increasing the size, diversity, and preparedness of the nursing workforce remains a national priority in the US.^{1, 2} Schools of nursing have increased efforts to attract and retain students from underrepresented groups,^{3, 4} but results have fallen short,⁵, leading to a shift in focus from diversity to inclusion. Inclusion—the intentional incorporation of practices that promote meaningful interactions among persons who differ in traits, perceptions and experiences³—is associated with student engagement, motivation,^{6, 7} and sense of belongingness.^{8, 9} These in turn may be associated with measures of student success.^{6, 9, 10} Yet, a dearth of evidence-based pedagogical strategies hinders creation of inclusive learning environments.

Study aims included describing: (1) relationships among inclusive pedagogical strategies and students’ sense of belongingness in the classroom and clinical setting, satisfaction and self-confidence in learning, and self-efficacy in the clinical setting; (2) students’ perceptions of inclusive pedagogical strategies; and (3) differences between majority (MS) and under-represented minority students’ (UMS) perspectives.

Methods: A longitudinal mixed methods study was conducted. 4^th-year baccalaureate nursing students ( n = 81) completed questionnaires 3 times during the academic year. Each semester, 2 focus groups were conducted, one with UMS, the other with MS.

Results: For classroom belongingness, results of two-way ANOVA showed a main effect for group, (F(1, 60) = 8.15, p = .006, ηp2 = .12), but not for time, and no interaction effect; indicating UMS consistently reported lower levels of classroom belongingness.

For clinical belongingness there were main effects for group, (F(1, 60) = 9.09, p = .004, ηp2 = .13, and time, F(2, 60) = 5.27, p = .006, ηp2 = .08), and no interaction effect. Post hoc analysis with a Bonferroni adjustment indicated all students reported higher sense of belongingness in the clinical setting at the end of fall semester (p = 0.36). However, scores in both UMS and MS dropped during the second semester. UMS scored consistently lower than MS.

Satisfaction and confidence in learning, (t(60) = 5.53, p < .001, Cohen’s d = 0.77), and perceptions of competence and self-efficacy in the clinical setting, (t(60) = 5.19, p < .001, Cohen’s d = 0.53) in both groups were significantly lower during spring semester than at the end of fall semester.

Findings from qualitative content analysis of focus group data supported some survey findings and clarified others. Findings from both indicated teachers strongly influence students’ sense of belongingness, which may lead to positive outcomes. Furthermore, strategies including learning students’ names, spending time with students outside of class, sharing stories and modeling professional behavior were strongly associated with inclusivity. During focus groups UMS shared many examples of unaddressed breaches in inclusivity which undermined confidence and sense of belonging. This helped to explain their consistently lower survey scores. Similarly, during the second focus groups participants characterized the spring classroom environment as less inclusive than the fall, which may account for the lower final survey scores.

Conclusion: Results may assist current faculty and inform future interventions. Further research examining inclusive education’s impact on nursing practice and patient outcomes is warranted.