Abstract
Introduction
Nationwide nursing shortages continue to impact the care and well-being of patients and facilities. In response, academic institutions have retrospectively started to address an important missing link: diversity. Members of URM groups continue to face significant barriers to entry into college, nursing practice, and representation within the healthcare environment. The most recent report by the Health Resources and Services Administration (2024) highlighted that the racial gap is closing as the proportion of non-Hispanic White nurses decreased from 73% in 2018 to 67% in the most recent survey, indicating a trend toward greater diversity within the profession. Despite this improvement, further efforts are needed to create a diverse nursing workforce, which is essential for progression towards achieving health equity in the United States.
In response to this report, this study developed a new educational program called the Summer Nursing Symposium (SNS) to a) target the various barriers that URM groups face, and b) create a link between high school and college to better assist URM students. The week-long program recruited local high school students via an application process; instruction occurred at a local public university and focused on the college application process and the fundamentals of nursing practice, research, simulation, and shadowing experiences to inform URM students and provide them the knowledge to pursue nursing as a college major and career.
Review of the Literature/Background
Despite the progress made in educational techniques, URM populations struggle to access higher education. According to the National Center for Education Statistics (NCES, 2016), there were significant gaps in educational attainment among different racial groups. By the age of 29, 65.6% of Asians and 42.9% of Whites had completed a four-year degree compared to only 22.7% of African Americans and 18.7% of Hispanics (Cuellar & Gándara, 2021; NCES, 2016). Kim and Smith (2021) stressed the need for interventions to promote equitable access. Looking at URM student populations, Llamas et al. (2021) conducted a longitudinal study that examined how student and faculty racial and ethnic matching affected grade point average (GPA) and graduation rates for URM students. When students were paired with faculty of a similar race, students achieved higher GPAs and graduation rates. In short, participants taught by URM instructors are more likely to perceive their dream of becoming a nurse as achievable. Building a successful SNS required the recruitment of URM nurse educators and other leaders representing URMs, within the nursing profession, as possible.
Ensuring URM success in higher education remains challenging. In recent years, higher educational institutions have started targeting first-generation, low-income, and underrepresented students to increase URM success. Despite these advancements in educational access, the completion rates among these student populations remain low (Kezar & Kitchen, 2020). Numerous articles have discussed how colleges experimented with various interventions to improve the success of underrepresented and underserved students, such as first-year experience courses to develop college knowledge (Goldstein, 2023; Kezar & Kitchen, 2020; University of Washington, 2024). In building the SNS, the authors utilized the various learning approaches in these earlier studies (such as simulation, hands-on, and shadowing experiences) to create a comprehensive educational environment aimed at synergistically providing a targeted approach to the URM student.
Evidence has demonstrated that traditional methods of nursing education are losing tenacity as a reliable source of educational delivery, which was a concern in building the SNS. According to Al-Ghareeb and Cooper (2022), simulation as an adjunct to typical lecturing demonstrated favorable outcomes when compared to traditional approaches of instruction. Further, Ironside and McNelis (2015) observed a trend toward integrating technology and active learning strategies in teaching pedagogy. Adopting engaging activities often allow students the flexibility for critical thinking and active participation. Moreover, Adeyemo and Oluwatosin (2019) highlighted that simulation creates realistic scenarios allowing for direct application of theoretical knowledge. Together, these studies push for integrated approaches to nursing education that involve learning within practical approaches, whether or not these methodologies include simulation, case studies, or other engaging activities over traditional lecture-style learning. Today's nursing education must encompass a wide variety of instructional modalities to meet diverse student learning needs.
The method of knowledge delivery is also important to consider. In the era post-COVID, many academic institutions have continued courses virtually. However, virtual teaching, though meeting the needs of a small subset of the student population, does not encompass equal success as on-ground courses. Despite this, Sugathapala and Chandrika (2021) discussed no statistical significance between virtual and on-ground educational modalities when reflecting on retention of knowledge. Although contradictory studies exist, developing nursing skills require substantial critical thinking and proficient hands-on components, which further substantiates the importance of on-ground learning within the field of nursing.
Theoretical Framework
This study, as well as the creation of its new SNS program, was based on the principles of constructivism, which focus on utilizing instructors as facilitators while learners gain knowledge through active engagement. By engaging students in simulation, classroom activities, group work, and hospital rotation, participants were offered a multi-pronged approach to knowledge acquisition through immersion.
Research Questions
Do students who participate in the SNS feel better prepared for the college application process?
Do students who participate in the SNS better understand the nursing role?
Methods & Design
The SNS was a week-long, in-person, summer symposium hosted by a local public university. Participation was limited to 20 students. Each day students were given a survey to establish their prior knowledge related to a certain nursing activity. Students would then be given a hands-on experience followed by another survey with the exact same questions to measure how their perception changed. Both the pre- and post-surveys used a five-point Likert scale with (1 – Poor, 2 – Fair, 3 – Good, 4 – Very Good, 5 – Excellent) for each question, where the number of questions ranged from six to ten.
In this pilot study, the goal was to determine whether there was a significant improvement in the students’ perceived level of knowledge on various nursing topics. Due to the non-numeric, ordinal data, the Wilcoxon signed-rank sum test was used to assess the differences between pre- and post-surveys for each day.
Recruitment
Following International Review Board (IRB) approval (IRB #695), researchers recruited 20 students who were queried by local high school guidance counselors and informed them of the program's mission and goals. Pamphlets were given to students known to meet eligibility criteria but offered to all students. To be considered for the study, students completed an application that focused on their underrepresented minority status, level of interest in nursing after high school, academic standing, and town of residence. Following this application process, URM students from local high schools were recruited into a weeklong, in-person SNS hosted by a local state university.
Symposium Design
The SNS's educational design promoted student learning through constructivism via a case-based approach in a laboratory setting. SNS participants were offered a variety of nursing skills through demonstrations and hands-on supervised practice. Once learned, these skills were assessed via simulation-based learning (SBL). SBL is a pedagogical approach that offers a safe, yet realistic, environment for clinical skill and decision-making acquisition (Tamilselvan et al., 2023). Multiple simulations were built into the SNS curriculum with incrementally increasing student-required problem-solving skills. The skills gained from these activities prepared the students for shadowing experiences within a local hospital environment.
The week-long intensive program focused on:
The college application processes: including presentations from college admission teams and faculty from the English department on writing a cover letter for their college application. College life: including a tour of the campus and dormitories. Fundamentals of the nursing process: with several experiences in the nursing laboratories. Evidence-based research: following presentations on research, students investigated and created their own posters for presentation. Simulation: participating in simulations on mannequins. Nursing shadow experiences: hosted at a local hospital with nurses.
The participants’ perceived level of knowledge on these topics was measured before and after the educational interventions to assess for significant change.
Results
Participants received daily surveys covering multiple topics throughout the week. For this research article, two research questions were poised. The first question is as follows:
1. Do students who participate in the SNS feel better prepared for the college application process?
The topics addressing this research question occurred on day 2 of the symposium. In order to address this research question, the following survey questions were asked: How would you rate your knowledge about…
Day #2:
Q1…the college application process. Q2…creating a college portfolio. Q3…your ability to write a college essay.
The Wilcoxon signed-rank sum test was used to quantitatively determine if there was a significant difference between the three pre, post survey questions. Table 2.1 (offered as a supplemental file) revealed statistically significant differences at the 5% level of significance with p-values of (.0232, .0429, and .0219) respectively. Furthermore, the effect size which measures how significant the differences between pre and post distributions are while controlling for sample size was considered large for question 1 and 3. In addition, Figure 2.1 (offered as a supplemental file) displays the Likert Scale distribution for question 1 through 3. Question 1, 2, and 3 saw a 44%, 39%, and 39% decrease from pre to post in responses of ‘poor’ and `fair’ respectively. That is, there was a significant shift in the distribution of students that felt much more confident with the college application process and their ability to write a college essay after the day 2 symposium.
The second research question is as follows:
2. Do students who participate in the SNS better understand the nursing role?
The topics addressing this research question occurred on days 1, 2 and 3 of the symposium. In order to address this research question, the following survey questions were asked: “How would you rate your knowledge about…
Day #1:
Q7…the types of supplies used in nursing. Q8…the types of procedures a nurse performs. Day #2:
Q4…performing CPR during an emergency. Q5…caring for a pediatric patient using simulation. Day #3
Q6…caring for a pregnant patient using simulation. Q7…caring for an adult patient using simulation. Q8…caring for a geriatric patient using simulation. Q9…stopping bleeding in a trauma patient.
Tables 1.1, 2.2, 3.1 (offered as supplemental file) show the results from the Wilcoxon signed-rank sum test for the eight questions listed above across days 1, 2, and 3 of the symposium respectively. All eight questions were statistically significant at the 1% level of significance with p-values of (<.0001, .0005, .0005, .0007, .0052, <.0001, <.0001, <.0001) respectively. The effect sizes were approximately 2 times larger for each of the eight questions (except for Q6 on Day 3) compared to the three questions used for research question 1. Figures 1.1, 2.1 (offered as supplemental file) and Figure 3.1 (see below) displays the Likert Scale distribution for eight questions listed above. Question 7 and 8 on Day 1 saw a 58% and 53% decrease from pre to post in responses of ‘poor’ and ‘fair’. That is, after Day 1 of the symposium no students rated the types of supplies or procedures used by nurses as ‘poor’ or ‘fair’. Question 4 and 5 on Day 2 saw a 72% and 56% increase from pre to post in responses of ‘very good’ and ‘excellent’. It appears students felt very confident about the process of performing CPR during an emergency. Lastly, Questions 7 through 9 on Day 3 saw significant decreases of (76%, 81%, and 81%) respectively from pre to post in responses of ‘poor’ and ‘fair’. In all eight questions used to answer Research Question 2, there was a dramatic shift to the right in the Likert Scale rating distribution for the post group compared to the pre group. For example, Q9 – Stopping bleeding in a trauma patient went from 81% of students responding with ‘poor’ or ‘fair’ prior to the demonstration to 95% of students responding with ‘very good’ or ‘excellent’ after the demonstration. This shift indicated that the students’ opinions regarding the research question “better understand the nursing role” had significantly improved after attending the symposium.
Likert Scale Distribution for Day 3 (Research Question 2).
Discussion
The SNS educational program demonstrated statistical significance in the quantitative, self-reported knowledge gained by students from the daily educational interventions, which suggests overall programmatic success in knowledge acquisition. The program's goals of creating an accessible route to college application were reinforced in the strong statistical significance with the topics of (1) successfully creating a college portfolio, and (2) the ability to write a successful college essay when applying to college. These students felt more prepared to apply to college after these educational modalities. Furthermore, students felt particularly competent in the areas of (1) performing CPR during an emergency, (2) caring for a pediatric patient using simulation, (3) the types of supplies used in nursing, and (4) the types of procedures a nurse performs. These results highlight the importance of in-person learning within the role of nursing education. Given that the great majority of student participants were URM, this program was successful in reaching these types of learners.
Various qualitative, open-ended comments were provided by the students including: “Make the week longer,” “I didn't realize how much we learned,” “I loved learning new topics,” and “The labs were very helpful.” These comments suggest the program's subjective success in reaching the URM students. Continued tracking for participant college admission rates may provide evidence in the setting of a longitudinal study. Although subjective statements by students do not provide objective support for the program's claims, it is important to note that students were energized and invested in on-going learning.
Limitations
This study was conducted as a pilot, carrying inherent limitations. Its goal was not to test a hypothesis, but rather to assess the feasibility of the study's components to be used in a larger-scale study (National Center for Complementary and Integrative Health, 2020). This study was conducted in the northeast region of the United States; therefore, the results cannot be generalized to all settings. This study contained a small sample size. A replication study should utilize a much larger sample size and consider multiple academic sites. Additional studies may consider adding a virtual simulation as an option to evaluate different educational methodologies.
Conclusions & Future Research
Original research outlining a comprehensive educational program designed to attract high school students from URM/disadvantaged backgrounds could assist in promoting successful academic outcomes. This SNS program offered original programming to introduce nursing as a career to high school students. The survey results indicated that students found the topics helpful in both preparing for college and increasing their interest in the nursing profession. Future research should be conducted with formative assessments establishing quantitative and measurable outcomes for programmatic development tailed to the URM learner. Furthermore, a longitudinal study evaluating the success rate of participants’ acceptance into nursing programs and graduation rates would provide a clearer measure of programmatic success.
Supplemental Material
sj-docx-1-hci-10.1177_15404153251342747 - Supplemental material for Summer Nursing Symposium: An Immersive Educational Program Inspiring Underrepresented Minorities for College and a Career in Nursing
Supplemental material, sj-docx-1-hci-10.1177_15404153251342747 for Summer Nursing Symposium: An Immersive Educational Program Inspiring Underrepresented Minorities for College and a Career in Nursing by Joshua N. Knickerbocker, Maria D. Krol, Andrew Bartlett, Kristen Borgognone and Kelly Martinez in Hispanic Health Care International
Footnotes
Acknowledgements
Yale-New Haven Hospital and New Haven Public Schools
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval and Informed Consent
IRB: #695. Informed consent was acquired from all underage participants.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
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