Fostering Cultural Safety in Nursing Education: Experiential Learning on an American Indian Reservation

BACKGROUND: To improve health equity, especially for American Indian/Alaska Native peoples, cultural safety must be included in the nursing education curricula. Cultural safety requires self-reflection with an examination of one's own culture and an ongoing analysis of biases and power imbalances. METHODS: Using a case study approach, a description and discussion of an ongoing Baccalaureate nursing clinical immersion experience on an American Indian Reservation is presented. With travel to the Pine Ridge Reservation, nursing students offer health promotion at community events and partner sites, with a focus on prevention of heart disease, diabetes, and unintentional injury. Transformative Learning Theory provides the foundation for the nursing clinical immersion experience at the Pine Ridge Reservation. Nursing students reflect throughout and after the Pine Ridge clinical experience via blogging. RESULTS: Cultural safety themes identified in nursing student reflections include critical consciousness; providing a safe place; seeking to understand historical trauma; and acknowledging power imbalances. Satisfaction surveys are completed by Lakota screening participants, and results provide further evidence of emerging cultural safety. IMPACT STATEMENT: A clinical immersion experience at an American Indian Reservation can foster cultural safety while also encouraging transformative learning. CONCLUSIONS: Nursing educators should consider clinical experiences focused on American Indian/Alaska populations. With a service component, the clinical immersion at the Pine Ridge Reservation requires that participants reflect on their experiences. A transformative change in perspective, required for cultural safety, is often the end result for nursing student participants.