Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Suzanne Lehman


Doctor of Nursing Practice


Cultural competency teaching and bias training has made its way into academic programs; however, these programs often lack the acknowledgment and importance of the ecological aspects of health. Ecological aspects of health (EAH) are described as physical and sociocultural environmental influences that affect a person’s health (Sallis & Owens, 2015). Education influenced by cultural competency poorly addresses structural racism in health care delivery and fails to address social, historical, and economic ideologies that play a critical role in provider and institutional biases (Tsai & Crawford-Roberts, 2017). Cultural competency teaching, or the understanding that there is a cultural difference and response to cultural differences to reach different cultural groups, also often perpetuates stereotypes as the cause of health disparities by indicating the existence of a stereotype and not the historical context in which the stereotype may have originated, not just the implicit bias from providers that may influence these stereotypes (Cultural Competence in Health and Human Services | Npin, 2020; Tsai & Crawford-Roberts, 2017). In a study conducted by Hoffman et al. (2016), of the 121 participants, despite having no genetic difference in pain receptors, there are a substantial number of medical students (α= 0.92) who continue to believe there is a biological difference in pain tolerance, that African Americans have a higher pain threshold than Caucasians. Not only does this lack of knowledge create mistrust, but research also indicates that implicit biases are significantly related to and associated with interactions between the patient and health care provider, treatment options, patient adherence to the treatment plan, and the health outcome of the patient (Hall et al., 2015). Through simulation, implicit bias training, cultural fluency, cultural humility, and EAH can help mitigate the lack of knowledge many students may have.

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