An article from Sponsored Preparing nursing students to deliver culturally aware health care Published March 17, 2025 By Jeanmarie Koonts

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Excellent nursing care has always been equated with providing safe, appropriate and compassionate patient-centered care. Embodying these qualities are a must for any nurse, and these principles have always been a hallmark of nursing education.

Providing care requires a deep understanding and respect for the differences that may exist among patients, such as variations in appearance, dress, dietary habits, religious practices and beliefs. It involves recognizing and valuing these differences to deliver compassionate and personalized care that honors each patient’s unique identity and experiences.

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This work, driven by the impact of social determinants of health and the link between spirituality and better outcomes, emphasizes dialogue, bridge-building and intercultural competence. Through engaged teaching, I help students recognize, appreciate and incorporate differences, fostering a deeper understanding of how these factors influence patient care.

To facilitate understanding of these issues in the classroom, I designed an interactive puzzle to help nursing students embrace holistic, patient-centered care and learn to appreciate the variety of factors that inform patient’s lives and their health care decisions. Factors such as culture, gender, community, faith and spirituality can significantly impact people’s health and decisions. 

Students begin the project with a blank puzzle in the shape of a human body. Each week in class, as students study the body system, learn to assess that system and practice on each other and mannequins, they gain clinical knowledge and skills.

But clinical skills alone are not enough to provide holistic care. Students need knowledge, comfort and exposure to factors that impact patient care and decision making. After focusing on hands-on skills, I work to help nursing students grow in intercultural competence and humility by incorporating learning about various cultures, diet, dress, rituals, faith/spirituality practices and their impact on care. We seek to understand, for instance, how a Sikh patient’s head covering is rooted in their belief of modesty and preference for a same sex health care provider. We explore Muslin patients’ preference for a pork-free diet and which patient population might be more likely to refuse blood products, among other topics. My goal is to challenge students’ preconceived assumptions and comfort levels and encourage them to see things through the patient’s eyes.

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The final step in the puzzle project is for students to “decorate” their puzzle to understand that each patient is far more than the sum of their parts. Through this project, they not only gain a deeper understanding and awareness of their peers and become more connected as a cohort, but they are also left with tangible models representing intercultural awareness and competency — the ability to understand, respect, care for and work well with people from diverse backgrounds.

Another important factor in developing nursing students’ intercultural competence is enhancing their faith/spiritually literacy, which takes center stage in my Bridging Faith and Health initiative. Along with colleagues from the Elon University religious studies department, this interdisciplinary initiative brings together pre-licensure nursing, physician assistant and physical therapy students (as well as their faculty and staff) to explore and discuss the impact of faith, religion and spirituality on holistic patient care and health outcomes. Over three weeks, participants explore modules that cover the importance of faith in care, the role of spirituality in supporting patients’ religious needs and insights from religious leaders on providing care.

Through interactive dialogue, case studies, panel discussions and evidenced based-practice, students build religiosity knowledge, communication skills and awareness to better support patients who incorporate faith, spirituality and/or religion into their health care decision-making. For example, in a case study that explored end of life rituals, students discussed how they could honor a patient’s wishes that the deceased remain untouched, intact (no organ donation) and unmoved for a period in today’s fast-paced inpatient hospital environment where bed space is limited. Upon completion of the series, students earned a micro-credential on Faith and Health literacy while building bridges to better holistic, individualized patient-centered care.

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Throughout every term, I constantly return to my guiding question: What does excellent nursing care look like and how can I teach nursing students to deliver this care? To me, it is patient-centered and holistic care — care that takes cultural awareness and spirituality into account, is compassionate and evidenced-based. In other words, excellent nursing care is delivered by an emerging nurse who understands, recognizes and appreciates that delivering care through the patient’s eyes can turn a life around.

Elon University Assistant Professor of Nursing Jeanmarie Koonts, MSN, CNE, has held a variety of clinical and academic positions throughout her professional career. Through dialogue, bridge-building and engaged teaching strategies, she strives to help students recognize, appreciate and incorporate the differences they experience to better serve their patients.

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