| a specific shortage of bilingual, bicultural nurses
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| Saturday
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Donna Reyes created one of her most valuable medical tools.
registered nurse who works with expectant mothers, Reyes filled eight pages of a spiral notebook with handwritten questions in rudimentary Spanish so she could communicate with Spanish-speaking patients who had immigrated to Delaware.
¿Tiene dolor por las contracciones? Do you have pain due to contractions?
¿Tiene dolor? Do you have pain?
¿Dónde le duele? Where does it hurt?
“I would take it right in the room with me when I was talking to the patients,” Reyes said of the notebook, which sits on her desk at Westside Family Healthcare. “I still have it here.”
She rarely needs it now. Having worked with so many Hispanic patients in her four years at Westside, Reyes has mastered just enough Spanish to do her job.
Increasingly, patients at Delaware’s federally-qualified health centers, which serve as safety nets for the indigent, hail from Central America, South America and the Caribbean. They labor as landscapers in Wilmington, poultry workers in Georgetown and mushroom farmers across the border in Kennett Square, Pa.
Delaware faces a general nursing shortage over the next decade, but it also faces a specific shortage: nurses who can communicate with the growing number of Spanish-speaking immigrants. The fear is, that with few Spanish-speaking health care workers, those who speak Spanish only, or little English, will be less likely to seek medical treatment.
“There is a specific shortage of bilingual, bicultural nurses,” said Maria Matos, executive director of the Latin American Community Center. “Those who do not speak English well are less likely to see health care for a chronic disease.”
Matos is on the Governor’s Consortium on Hispanic Affairs, which commissioned a recent survey that found that 22.3 percent of Hispanics won’t seek out a doctor or nurse for a checkup because they are not proficient in English. More than one in four Hispanic adults in the United States lacks a usual health care provider, according to the Pew Hispanic Center.
“Part of the reason is that they don’t understand what’s going on and they don’t understand the health care profession,” Matos said. “You’re less likely to go back to a place where people don’t understand you and where you came from.”
Delaware saw the country’s 19th highest rate of growth in its Hispanic population from 2000 to 2007, rising 51 percent to about 56,000, according to Pew Hispanic Center tabulations of U.S. Census data.
A report by the Delaware Health Care Commission on the First State’s nursing shortage found that fewer than 1 percent of nurses were Hispanic.
Delaware should respond by training more nurses to be culturally competent, said Dr. Jane L. Delgado, a psychologist who heads the National Alliance for Hispanic Health.
“You also need to train the people that you already have there. It’s like if you lived in a community and went from serving teenagers to serving an older population,” she said. “You would have to change what you do.”
Strangers to health system
The language barrier is just one of many problems. Challenges occur because many immigrants — legal or not — don’t understand how the U.S. health care system works.
Many don’t understand the concept of prescriptions. When their medicine runs out, some fail to return for refills. Since many are uninsured, they skip appointments if they can’t pay.
Some wait until their illness becomes debilitating before seeking help. Some pregnant women, having given birth before without the guidance of a medical professional, wait until the third trimester before going for prenatal care. Some fear they’ll be ridiculed for their home remedies and don’t divulge them, running the risk of violent interactions with prescribed drugs.
Crucial to improving these patients’ health and increasing their knowledge of health care is a favorable first visit.
“Nurses have that very unique role where they are closer to their patient than the doctors and other health professionals,” said Delgado. “They are much more attuned to what the patients are dealing with.”
When Reyes was a nursing student at the University of Delaware, she took a class on providing culturally competent care. After graduating with a bachelor’s degree in nursing four years ago, she joined Westside Family Healthcare, the largest federally-qualified health center in Delaware, with three clinics in New Castle County. Fifty-one percent of the patients who go to Westside are uninsured and 39 percent are on Medicaid, the federal-state insurance program for the poor.
She started at the center’s West Fourth Street location in Wilmington and now works at the Newark office, where about half the patient base is Hispanics who speak only Spanish.
Translations a problem
The proportion of Hispanic patients at Westside Family Healthcare is 64 percent. At La Red Health Center in Georgetown, it’s just slightly lower — about 60 percent — and most of them speak Spanish only. The other two local organizations that run federally-qualified health centers — Henrietta Johnson Medical Center and Delmarva Rural Ministries’ Kent Community Health Center — also treat immigrant patients, though not as many. Because questions about immigration status are not directly related to health, patients do not have to reveal whether they have illegally entered the United States.
When a translator isn’t available at the centers, sometimes a patient’s bilingual child is asked to translate. Misunderstandings can arise out of this situation, leading to medical errors, according to the National Center for Cultural Competence at Georgetown University.
La Red has four translators and several bilingual employees, said Barbara Richards, a registered nurse who helps expectant mothers. But it would be preferable if nurses could communicate with patients directly, she said.
“We need to decide whether they need to come in and see a doctor or go to the hospital or take a Tylenol,” said Richards, who does not speak Spanish. “In order to do that you really need to be able to communicate with them rather than having someone else translate the entire visit.”
Richards has memorized questions she needs to ask her patients in Spanish.
“I can get through most of my translation without assistance, but if there’s anything new that they have to say, or if I have my doubts about what they’re saying, I’ll have to run and grab a translator,” she said.
With many of those patients, she has to spend several minutes trying to gain their trust.
“No matter what country they’re from, they tend to not want to give away all their private information when they first meet you,” she said. “You have to take some time to warm up with them, and explain to them that whatever they tell us is confidential and will not be going outside the doors.”
Six months pregnant
Many pregnant patients at La Red do not seek care until they are in their sixth month, too late for some tests on the fetus’ health.
Often, the visits are complicated because patients do not want to admit they don’t understand what is being said.
“You have to explain the importance of what they need to do and explain it multiple times,” Reyes said. “I’ll do a lot more pointing and use a lot more motions.”
That means some visits that should last 30 minutes go on for an hour and a half.
Over the years, the Hispanic community near La Red has become more trusting of the center. But many are still reluctant to seek help because they fear that they won’t be able to afford the cost or will risk exposure of their immigration status.
“I can’t give you an exact percentage, but probably half the patients I see have something that should’ve been taken care of a long time ago,” Richards said. “They are showing up at the door really sick.”
Immigration issues can severely complicate care. A recent Hispanic patient of Reyes’ was a mother who had diabetes and a sexually transmitted disease. Her boyfriend was arrested for physically abusing her and deported. The boyfriend had been paying for her medicine. She couldn’t afford the medicine on her own and had to stop taking it.
“When you have to choose between food and other things that you need, you might have to make the decision where you won’t go see the doctor,” Richards said. “They’ll ask if there’s something they can do over the phone rather than having to come in and be seen.”
Many will visit botanicas, which sell herbal remedies and provide access to curanderos, or folk healers. Richards asks Hispanic patients to list medicines and herbs they are using because of potential interactions.
Reflecting the change in the patient population, nursing students at Wilmington University can obtain a Hispanic Cultural Certificate. The program consists of 18 undergraduate credits, including three Spanish-language classes, and students are required to practice in community health settings that treat Hispanic patients.
“We believe it’s important, because in order to treat someone appropriately, it is important that some of the health beliefs and values that other cultures may have are understood,” said Sheila M. Sharbaugh, coordinator of the bachelor of science in nursing program. “Different cultures have different beliefs with health and with illness.”
Jane Boyd, an instructor at Wilmington University’s Georgetown campus, teaches “Cultural Diversity in Health and Illness.” The course’s lessons range from immigrants’ cultural heritage to their sleep patterns to the type of work they do. Many patients who work in the poultry industry come to the emergency room with trauma-related injuries. Many of their children play soccer, making them susceptible to physical injury or heat exhaustion.
“How you seek care and how you respond to a provider is also based on your background,” Boyd said. “Some of the things we do are just like what they do. ... But to be culturally competent, you need to understand your world views and the views of the patient.”
Prenatal visit
On a recent day, Reyes met with 27-year-old Griselda, a Mexican immigrant who has had two children and one miscarriage. She came because she was pregnant again.
Griselda works in construction eight hours a day and speaks little English.
Reyes asked one question after another in Spanish. Each question was slow, and she hesitated several times, making sure that she was as clear as possible.
Reyes ran her hand across Griselda’s midsection and asked about her condition.
Reyes spoke to Griselda about nutritious diets and the dangers to a fetus from periodontal disease. Care in the United States is much different than in Mexico, Griselda said.
“If you have money you get seen more often there,” she said through a translator. “But here they treat you and it’s affordable. I’ve learned what (healthy foods) to eat while I’m pregnant. I tell my friends about Westside.”
At the end of the appointment, Reyes ran a monitor across the her abdomen so she could hear her baby’s heartbeat. It was 150 beats per minute, ideal for a fetus of 25 weeks.
“Muy bien,” Reyes said.
These stories on the nursing shortage were reported with the assistance of the USC Annenberg/California Endowment Health Journalism Fellowships, administered by the USC Annenberg School for Communication. The News Journal was selected by the program in 2008 to report on the nursing shortage, with a particular focus on the impact on Hispanic communities.source
How to Become a Nurse |
posted by blogger @ 23:58
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