Student nurses in bilingual clinical residency address Latinx health inequities

When Dr. Sylvia Peña was just a teenager, a budding awareness of health inequities led her to reconsider plans to study biomedical engineering in college and instead pursue nursing.

The pivotal incident that started her on this new path happened when she was volunteering at a hospital reception desk and witnessed a Spanish-speaking mother struggling to secure help for her sick baby from English-speaking emergency room staff. Because Peña spoke English and Spanish, she stepped in to help the mother communicate her baby's needs.

"Being part of the Hispanic community, you see all these inequities growing up that you don't know are inequities," she says. "Then you learn, that's not supposed to happen."

Today, as an assistant professor of nursing at Marquette, Peña is committed anew to addressing the inequities that disproportionately add to the health burden of Latinx people, including language barriers, lower rates of health insurance coverage, and diet and life conditions that put them at greater risk for developing diabetes, kidney failure and other diseases. Supported by awards from foundations that share her commitment to reducing inequities, she's bringing important resources and innovative strategies to bear against these challenges.

A prime example is Peña's project, supported by a $50,000 grant from AARP, or the American Association of Retired Persons, to establish a community-focused bilingual clinical residency for Marquette nursing students that specializes in providing bilingual dietary guidance to a largely Hispanic population of guests at the Milwaukee Christian Center.

Launched last fall, the unique clinical program operated for two semesters, immersing a dozen undergraduate nursing students in preventive health care work and supporting more than 450 community members. The program complemented the Milwaukee Christian Center's food pantry, where center leaders noticed a need for culturally competent education to keep guests from struggling to turn their chosen food into healthy meals.

To be sure, something more than generic nutritional education was called for. Many food pantry guests understand medical guidance - and recipes - best when expressed in Spanish. And most had a particular need - how to adjust the traditional ethnic meals they know and love so the dishes put them at less risk for conditions such as diabetes and cardiovascular disease.

Enter the student nurses, who spent one day per week at the site over the course of each semester, typically for six to eight hours at a time. Their initial focus each week was education and the development of therapeutic communication skills. After creating a nutritious recipe incorporating items available at the pantry that week, the students would present the recipe to assembled guests and educate them about the effects of various ingredients on the body and on certain health conditions. "During the presentations, I would translate everything to Spanish after one of my peers explained it in English," says Marily Flores Carillo reports, a rising senior who also created printed versions of the recipes in Spanish for guests to take home. "Education is a significant role of a nurse, and the clinical consistently gave me the opportunity to build on this skill."

The care also regularly became more personalized. "My peers and I created different options for those who had specific allergies or underlying medical conditions," Flores Carillo reports. "We found ourselves proactively thinking about how every ingredient would be an asset to our recipe, making it a tasty, nutritional, and culturally appropriate recipe."

Before working at the clinical site, students prepared for the experience in the College of Nursing's clinical simulation lab, where they engaged in care scenarios such as educating and advising a pre-diabetic patient who only spoke Spanish.

We are thinking about how we can make an impact outside of the hospital to prevent people from being hospitalized.

Dr. Sylvia Peña

From Peña's perspective, the benefits of the clinical fell into two main camps. The first were experienced by MCC guests. "We're thinking about how we can make an impact outside of the hospital to prevent people from being hospitalized," she says.

The second set of benefits were experienced by students. Led by instructors, students learned "to critically think about the implications of disease processes - such as diabetes and hypertension - and nutrition," she says. The clinical also gave students an important opportunity to build on therapeutic communication strategies, and cultural competence and humility skills, introduced to them in their first year of nursing study."Having students critically think and incorporate content learned in the freshman courses with the individuals they worked with at MCC helped avoid providing a one-size-fits-all health education model," Peña says.

Peña compiled data related to the bilingual clinical site, which will help generate a study about the effort. The findings will be presented at the annual conferences of the National Association of Hispanic Nurses and the International Association of Clinical Simulation and Learning this summer.

The community health clinical program aligns well with other projects led by Peña that are focused on reducing health disparities in the Latinx community. They include a study supported by a grant from the Healthy Americas Foundation to investigate the reasons for low rates of cervical cancer screening in Latina women, which contributes to high rates of cervical cancer diagnosis and death in the same population. Selected for this grant along with a cohort of 20 other researchers investigating this issue across the U.S., Peña, with her team, recruited 150 participants from the Milwaukee area for the study. Their research is currently in the data-analysis phase.

"I have a passion for dismantling these inequities," she says.

More broadly that passion includes equipping and empowering Latinx people to become nurses, health care providers and health educators. "While attending nursing school, I didn't have a professor who looked like me - who was Latina - until my graduate studies," she recalls.

As a case in point, this issue of limited representation emerged as a factor this spring that cost the project team an opportunity to extend the clinical residency at the Milwaukee Christian Center for an additional year.

"We unfortunately could not find a clinical instructor who was bilingual to mediate any language barriers between the community members and students for the following year," Peña says.

For Flores Carillo and other students who participated in the program, the value of their clinical experiences endure, however. Recalling how she honed her therapeutic approach as she checked in with MCC clients week after week -making eye contact, asking questions, and focusing on her tone of voice and body posture. "It all had a large impact in building trust. Many people opened up about their lives, and others saved me a seat at lunch," she recalls. "I used my therapeutic communication skills to become a trusted student nurse."

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