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Investing in Inclusion

In this issue of Changing Course, we will examine how to invest in inclusion. Inclusion is about meeting the needs of all learners. Students enter nursing programs with diverse learning needs.To maximize learning opportunities for all nursing students, an equitable, accessible and inclusive learning environment is critical to course design. There is no one-size-fits-all to nursing education. Inclusion should not be an afterthought, we need to start thinking about it when planning courses. Planning is the best time to consider Equity-oriented design (EOD). EOD is a framework for proactively creating inclusive and accessible learning environments and experiences and gives every student the opportunity to achieve fair and comparable outcomes regardless of background, ability, or life experience (University of Tennessee Chattanooga, 2021). The need for EOD is well supported and it is important to intentionally include EOD into nursing courses to meet the needs of all learners.

Getting Started with EOD

Investing in inclusion takes time. Here are four questions you can ask to get started with EOD:
  • Do you have access to an accessibility report tool for your learning management system (LMS)?
  • Is there diverse representation in course materials?
  • Do images, videos, and voice recordings follow best practice?
  • Do you use Universal Design for Learning (UDL)-aligned teaching strategies?


Accessible design facilitates inclusion. “Accessibility is the practice of making information, activities, and/or environments sensible, meaningful, and usable for as many people as possible” (SeeWriteHear, 2022, para 1). In relation to nursing education, we need to design courses that provide a student with the ability to interact fully and productively with the content (SeeWriteHear, 2022).
To assess the overall accessibility of your course, see if you have access to an accessibility course report. I used the Canvas integration tool Ally, to generate a course accessibility report. The report provides:
  • A score to measure the accessibility of content
  • Feedback and support about accessibility issues
  • Information about severity of issues
  • Instructions on how to fix accessibility issues
  • Alternative formats for course content (Blackboard, 2022).
With an accessibility course report you can decide which areas are the most important and the easiest to fix first. For example, my Ally Course Accessibility Report identified images as a major issue and then assisted me in fixing the problem. As a result, I easily added alternative text to 192 student facing images and increased my accessibility score by 10 points.


Including course materials that represent diverse perspectives such as ethnicity, gender, sexuality, and ability fosters an inclusive classroom (Cornell University, 2022). Nursing students come from diverse backgrounds and the need for pedagogical approaches that are theoretically appropriate, equitable, inclusive, and responsive to diverse perspectives has grown (National League for Nursing, 2017). Take a look at your course materials like readings, images, videos, and assignments. Ask yourself if diverse perspectives are supported? To improve diverse representation in my course materials, gender neutral language was infused where appropriate and readings, images, videos, and assignments were diversified to include variations in race, ethnicity, age, gender, sexuality, and ability.
Additionally, nurse educators must be mindful of their own values and beliefs in meeting the needs of their students (National League for Nursing, 2016). It is important that nurse educators take the time to explore personal bias and learn about diversity and inclusion. We must be willing to grow and overcome barriers to achieving diversity in education. Nurse educators are responsible to take advantage of opportunities to explore bias and learn more about diversity, equity and inclusion. I challenge you to begin the journey. Here are some resources to get started:
1. Cavallo, C. (2021). Offering a path to success for everyone: Creating an inclusive environment in nursing education. Sigma Global Nursing Excellence.
2. Macy Foundation. (2021). Nursing: Taking action on harmful bias, discrimination in classroom and clinical learning environments. [YouTube].

Images, Videos, and Voice Recordings?

Course materials should be understandable by all learners. According to the Web Content Accessibility Guidelines (WCAG) 2.1, information must be presented to users in ways they can perceive (W3C, 2019a). When WCAG are followed, content becomes more accessible to a wider range of learners (W3C, 2018). Some easy ways to ensure your course materials like images, videos, and voice recordings are perceivable is to:
  • Add alternative text to all images
  • Provide captions for videos and voice recordings
  • Use podcasts with transcripts
  • Use text-to-speech technology
Alternative text (alt text) is used to describe images so that the image can be read aloud by screen reader software (Harvard University, 2022). Alt text can be added to images in Canvas, Microsoft PowerPoint and Word, Google Sheets, and other software and applications. Generally, it is as easy as right-clicking on an image and adding the descriptive text. Check with your instructional design department to see what technology you have available to use. I was able to upload video and audio course material to Kaltura to generate closed captions and other accessibility features. I also only use podcasts with transcripts.
Many computers, devices, and software have text-to-speech technology. People who are blind, have partial sight, and have dyslexia or other cognitive learning differences benefit from text-to-speech technology (W3C, 2019b). I have access to Immersive Reader in Canvas which reads text aloud, and also has options to break text into syllables, increase spacing between lines and letters and has other functions to support unique learning needs (Canvas Team, 2021). Most importantly, demonstrate use of accessibility aids like captions and text-to-speech so that students know that it is available and how to use it.

UDL-Aligned Teaching Strategies?

UDL-aligned teaching strategies ensure that all students have an equal opportunity to learn (Prince George’s Community College, 2021). UDL Guidelines are based on scientific insights into how people learn and focus on providing:
  • Multiple means of engagement
  • Multiple means of representation
  • Multiple means of action and expression (CAST, 2018)
UDL Guidelines are meant to be a set of suggestions to reduce barriers and maximize learning opportunities for all learners (CAST, 2018). They should not be used as all or nothing requirements, rather as suggestions to support student learning. To align UDL guidelines with my course, I embedded a class activity that follows UDL principles. Other UDL-aligned strategies were implemented including: using a voice amplifier, providing classroom recordings and outlines for note-taking and using multimodal teaching strategies.

Start Investing

Equity-oriented design is an essential element of nursing course planning. It is important for nurse educators to intentionally include equity-oriented design into courses to support inclusivity and meet the diverse needs of all learners. Start investing in inclusion and watch your students grow and flourish!
Coming up in the next edition of Changing Course . . . . Breaking Up is Easy to Do!


Blackboard. (2022). Course Accessibility Report.
CAST. (2018). Universal design for learning guidelines version 2.2.
Cornell University. (2022). Incorporating diversity. Center for Teaching Innovation.
Harvard University. (2022). Write good Alt Text to describe images. Digital Accessibility.
Canvas Team. (2021). Immersive Reader in Canvas: Improve reading comprehension for all students. Instructure.
Cavallo, C. (2021). Offering a path to success for everyone: Creating an inclusive environment in nursing education. Sigma Global Nursing Excellence.
Macy Foundation. (2021). Nursing: Taking action on harmful bias, discrimination in classroom and clinical learning environments. [YouTube].
National League for Nursing. (2016). Achieving diversity and meaningful inclusion in nursing education: A living document from the National League for Nursing. NLN Vision Series.
National League for Nursing. (2017). NLN diversity & inclusion toolkit.
Prince George’s Community College. (2021). UDL aligned strategies. Library and Learning Resources.
Rutgers Canvas. (2022). Ally.
SeeWriteHear. (2022). What is accessibility.

University of Tennessee Chattanooga. (2021). Equity-oriented pedagogy and Universal Design for Learning (UDL) framework. 

W3C. (2018). Web Content Accessibility Guidelines (WCAG) 2.1.
W3C. (2019a). How to meet WCAG (Quick reference).
W3C. (2019b). Text to speech.



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