Developing curricula and pedagogy with a critical eye toward health equity, racial justice, and inclusion
Following the murder of George Floyd and worsening pandemic conditions in 2020, Nursing Outlook published an editorial by nursing school deans at the University of Pennsylvania and Duke University calling out racism as a disease that nurses and nurse educators must address to improve patient outcomes and create better workplaces. To meet its goal of creating classrooms where students learn how to promote health equity, the Connell School of Nursing (CSON) has been working to develop on-campus resources for students of color, and to make sure that both classroom content—what is taught—and pedagogy—how it is taught—equip all students to address health disparities in their careers.
When Karen Aldana ’23 arrived at BC as a first-year, she quickly became aware that the majority of her nursing school classmates were white. For Aldana, who believes representation is crucial in the field of nursing and at BC, finding community on campus was a priority. “What made that easier was the Seacole Scholars Program that Julianna González-McLean started our freshman year,” Aldana says.
At the time, González-McLean was CSON’s assistant dean of student services for diversity and inclusion. She co-created the Seacole Scholars Program as an intentional Living and Learning Community for first-year nursing students from underrepresented backgrounds, inspired in part by her own experience as a BC undergraduate in the mid-2000s. Back then, her dream was to be a psychiatrist. “I knew I could do it, but I didn’t make connections with faculty,” she says. “So I left pre-med after organic chemistry. Later, I wanted to be that mentor for the students who felt they were just getting by.”
“Guiding faculty toward new teaching norms will create classrooms where both students and educators feel empowered to learn.”
When González-McLean returned to campus in 2013 to work at the Connell School, she made it her mission to nurture a supportive learning environment for all future health care workers. Although CSON’s existing Keys to Inclusive Leadership in Nursing (KILN) program provided support to some 60 students each year, she felt the school’s efforts to serve underrepresented students like Aldana could be more robust. She envisioned a residential community where nursing students of color could choose to live together, take classes together, and have meaningful, guaranteed dialogue with faculty and campus leaders. Today, González-McLean is continuing this work at George Washington University School of Nursing as associate dean for diversity, equity, and inclusion, and Aldana is the resident assistant for the Seacole Scholars Program. Now an established community member and a mentor to boot, Aldana says the program has been essential to her BC experience. “It was helpful to have that community of individuals who identified similarly to me—who I could be comfortable with and express my feelings around. I made more friends because of it.”
Making education inclusive also means choosing the right course materials. The Connell School’s Baccalaureate Program Committee (BPC) has been partnering closely with Boston College’s Center for Teaching Excellence (CTE) to do exactly this. The committee is composed of nursing faculty, some of whom joined forces with the CTE’s Kim Humphrey to create a system for evaluating coursework.
An instructional designer, Humphrey has been a key resource during the ongoing evaluation process. While CTE instructional designers are not subject matter experts, they are teaching specialists who provide confidential support to BC faculty. Humphrey hopes to help teachers develop a critical eye toward their own biases (which can stem from class background, race, age, gender, and beyond) and expand their imagination of how various students might experience the classroom.
With this in mind, Humphrey created a curriculum review instrument to put faculty teaching under a microscope. This tool can, for example, help teachers have inclusive discussions about topics like disease processes that disproportionately impact non white populations. Framing health inequity as a product of systemic racism can both give students a more nuanced understanding of illness and help them connect with future patients on a more holistic level. The classroom, Humphrey says, is a place where oppression can either be reproduced or undone.
“Instructors ask different questions about inclusive teaching and come from different perspectives and backgrounds,” Humphrey says. For this reason, their approaches to designing course materials vary. Ultimately, she hopes that guiding faculty toward new teaching norms will create classrooms where both students and educators feel empowered to learn.
In 2021, Dorean Behney Hurley, a clinical instructor and BPC member, requested that CTE audit her core Pathophysiology course, which she has taught for more than 10 years. “It’s one of the very first classes that nursing students take, so I thought it was important that we should start from that perspective,” Hurley says. Over the fall 2021 semester, Hurley met regularly with Humphrey, González-McLean, and other CSON staff and faculty to comb through each section of her course material to update the course’s case studies and presentations to be as bias free as possible
One of Hurley’s goals was to make the images she shows to students more inclusive. “If you look in a lot of the textbooks, a lot of the references are only shown on white skin,” she says. Diversifying images is just one step in calibrating the nursing classroom toward inclusion, however. As the curriculum evaluation went on, Hurley began to talk about race and illness differently. This was particularly true during her unit on hypertension—a disease that disproportionately impacts non-white individuals.
“Where in the past I may have said, ‘This is what a person who has this disease looks like,’ I would now say, ‘This is a product of structural racism,’” she says. Her teaching is backed by the research of medical experts and by organizations like the American Heart Association, which cites structural racism as “a fundamental cause of persistent health disparities in the United States.” Hurley also adjusted her syllabus policies to be more inclusive, allowing greater flexibility for students given the effect the pandemic could have on their lives.
“I want to build relationships with students,” she says. “I want them to come to me if they need help.”
Student course surveys are already reflecting positive feedback to the changes, she says—a promising start.
“We don’t exist in isolation here in Chestnut Hill. If we do better here, our alums will do better wherever they choose to practice.”
Clinical Assistant Professor Jacqueline Sly, who is CSON’s former assistant department chair and a family nurse practitioner, credits much of her own teaching success to working with a largely non-white hospital population in Brockton, Massachusetts. Her work there motivates her to give students the curriculum they need to understand health disparities and improve patient outcomes. She cites CSON’s mission to educate nurses who provide scientifically based, humanizing health care as a reason to center health equity in the classroom. Like Hurley, Sly has worked with González McLean and the CTE to identify where she can improve her teaching.
“When you work on dismantling racism, you’re also stepping into racism, and that can feel like stepping into conflict,” she says. “Sometimes it’s hard, emotional work.”
While uncertainty is a natural part of the learning process, the payoff can be great. To Aldana, who was Sly’s Pharmacology student, the classroom felt more welcoming because of the open-minded environment. “Whether it related to the content or not, she gave us the space to talk about current events and how certain medications and drugs affect different populations,” Aldana says. With a year to go in her CSON education, Aldana is excited about her professional future in pediatrics and supporting premature babies in the NICU. For her, Sly’s teaching brought the outside world in.
With the 2022 spring semester unfurling, Dean Katherine Gregory wants to keep expanding the conversation about inclusive teaching and inequity in nursing.
Gregory, who earned a Ph.D. in nursing from Boston College and served as a faculty member from 2006 to 2014, is intimately familiar with the learning environment at CSON. In July 2021, though, she became dean at an unprecedented time. “Like any new leader, I have spent the majority of my time listening and learning to partner across the University to be effective,” Gregory says.
Academic excellence is Gregory’s number one priority as dean, and she sees anti-racist education as a cornerstone of this goal. “At the grassroots level, we have been very fortunate to have members of CSON lead book clubs, podcast groups, and reflection seminars to increase knowledge and competency with concepts related to diversity, equity, and inclusion,” she says. Gregory credits the partnership with CTE as one of the most effective methods the school has of weaving anti-racism through the nursing curriculum. With that work ongoing, she is setting her sights on the global CSON network.
“We don’t exist in isolation here in Chestnut Hill,” she says. “If we do better here, our alums will do better wherever they choose to practice.” She hopes alumni will reach out with ideas for enriching CSON’s mission and share their own experiences related to health inequities in the field.
“I don’t think there’s any wrong way to move forward. I think the key is moving forward together.” ▪