Try the all-new QuickBooks Online for FREE.  No credit card required.


Document Sample
Lienne-Edwards Powered By Docstoc
					          Crossing Borders:
  An Educational Model for Increasing
      Nursing Workforce Diversity
Lienne D. Edwards, PhD, RN      Tama L. Morris, RN, PhD, CNE
Project Director                Project Manager      

School of Nursing, The University of North Carolina at Charlotte

Need for Nursing Workforce Diversity
  to Decrease Health Disparities

Bureau of Health Professions Goal #2:
   Elimination of Health Disparities
                           Health Care Access Indicators
                                               White         Non-          Mecklenburg               NC
Percent without health care coverage             5.6         25.3                 13.5              17.8
(insurance, prepaid plan, or Medicare)

Percent of employed for wages without health     5.9          25.2                14.4              17.7
care coverage: Less than age 65

Percent without health care coverage: Less       6.8          27.3                15.6              20.9
than age 65

Percent not having personal health care         13.8          40.3                24.4              21.9

Percent not affording cost of seeing MD when    10.5          22.2                15.1              16.0
needed one in last 12 months

                                               North Carolina State Center for Health Statistics, 2006
Racial Diversity of NC in Last Two Decades
       Caucasian   African        Hispanic       Asian      Native
                   American                                 American

1987   89.3%       7.3%           .35%           0.19%      0.29%

1997   85.8%       7.6%           0.51%          1.3%       1.1%

2006   85.2%       9.5%           0.73%          2.2%       0.76%

         Source: North Carolina Center for Nursing, 2007b
•HRSA Nursing Workforce Diversity Grant

•Full funding for three years = $705,499.00

•Admit and support 10 additional diverse or
educationally disadvantaged students
per year
 Increase nursing education opportunities for
individuals from disadvantaged backgrounds,
     including racial and ethnic minorities,
who are underrepresented among registered
            Create a model educational program
 that will empower and support disadvantaged students
to succeed in nursing education, so that they may serve
      as role models and leaders for future nurses.
Phelan, P., Davidson,
A.L., & Cao, H.T. (1991,
September). Students’
multiple worlds:
Negotiating the
boundaries of family,
peer, and school cultures.
Anthropology &
Education Quarterly,
22(3), 224-250.
  Barriers Faced by


                       Academic Barriers
1.Inadequate secondary school preparation, especially in science.
2. Difficulty keeping up with academic standards.
3. Difficulty taking exams and doing group work.
4. Failure to use available counseling and campus resources.
5. Inadequate faculty student communications.
6. Absence of supportive relationships with faculty.
7. Fear of seeking help because of identification of failure.
                          Social Barriers
1.Alienation, isolation, and loneliness.
2.Absence of supportive relationships with other students.
3.Perceived indifference or negativism in Caucasian students and
4.Cultural and racial identity adjustment problems.
5.Problems with social and sexual relationships: peer pressure.
6.Difficulty in maintaining stable, supportive family relationships.
                       Financial Barriers
1. First generation college and families cannot provide support.
2. Limited income forces students to work while attending school.
    •Physical and Psychological energy required to work.
    •Loss of study time.
    •Loss of energy to study.
    •Scheduling issues and compromises.
                      Crossing Borders
Disadvantaged students constantly cross borders
between their own culture (world) and that of higher education.

Borders are:
       Easily crossed



            Themes of Border Navigation
PEPP Summer 1     Reflection and Preparation

SNAP Junior 1     Transition: Crossing into membership with
                  the full cohort of nursing students
SNAP Junior 1     Barriers and Bridges: Self awareness and
                  examining multiple worlds
SNAP Summer 2     Appreciating Vulnerable Populations

SNAP Senior 1     Healthcare and Cultural Awareness: Merging
                  self and others
SNAP Senior 2     Crossing the Border to Professional Practice
      Intrusive Advising                    Support:
                                          Scholarships &

 Cooperative                   Student
Education Plan                 Support:
                            PEPP & SNAP

                   as Mentors                   Service Learning
        Key Elements of Student Support
 Pre-Entry Preparation          Supporting Nursing
       Program                 Achievement Program

• Health Assessment        • Traditional Course Plan
  Course                   • BHPR speakers
• Diagnostic Educational   • Mentors
  Testing                  • Advanced Study Skills
• Study Skills             • Scholarships (based on
• Stipend                    eligibility)
                           • Summer Stipend
   Crossing Borders & Health Disparities

…unique elements of the program
• Focus on cultural competency in healthcare.

• Attend two presentations per year by university
  Multicultural Resource Center.

• Extra clinical course – “Appreciating Vulnerable
     Appreciating Vulnerable Populations

• Course focuses on 3 key factors:
   – Race and ethnicity
   – Socioeconomic status
   – Health insurance coverage

• Setting: general medical-surgical and maternity units in
  Charlotte and Wilmington

• Preceptors oriented to Crossing Borders program and
  course objectives
        Student Reflection on Experience

Working with a Spanish speaking client…

 “I realized how important communication is in a nurse-
  client relationship because no matter how much care we
  could have provided to this mother, if we could not
  communicate with her effectively and understand her
  concerns, we would not have been able to mitigate her
      Student Reflection on Experience

“By seeing many vulnerable populations in the summer
externship, I have had a very different experience in the
hospital now than ever before. I used to just look at the
medical conditions and reasons why the patient came to
the hospital to help make the patient better. Now, seeing
many vulnerable populations in this clinical experience, I
think as a nurse, there can be many things done in order
to help the patient feel better rather than just working on
their medical conditions.”
       Student Reflection on Experience

“I have learned a lot this summer during clinicals, and not just
from this case but my whole experience… Every day there I
have encountered countless vulnerable patients. I never
knew there were that many homeless, uninsured people in
Charlotte. Practically every patient on this floor is in need of
insurance, a home, or both. This experience has opened my
eyes to population of people I never knew and has broadened
my perspective on the vulnerability of patients in the “real
world”, and in the future has prepared me on how to handle
vulnerable populations.”
     Early Outcomes of
• 100% retention of two cohorts
• First cohort will graduate in
May, 2010
• Students report serving as
resources for their peers
• Students report appreciation
of support and relationships
developed with program faculty.
•Health Assessment course
teaching methodology changed
for all students in the program.
                  Lessons Learned
• Like vulnerable clients, the students in the Crossing
  Borders grant are vulnerable students with unique and
  individualized needs.

• All students need to learn to work with co-workers and
  clients who are different from themselves.
Questions ?