The populations within the five boroughs of New York City (NYC) come from multiple cultures and speak multiple languages. To provide culturally and linguistically competent health education and disease prevention to this population, a public nursing school and certified home healthcare (HHC) agency collaborated on an Influenza Initiative.
Healthy People 2010 asserts that "appropriate information and communication with a provider not only can relieve patients' anxieties but also can help patients understand their choices, allow them to participate in informed decision making, and better manage their own health concerns" (U.S. Department of Health and Human Services, 2000, pp. 11-17 & 11-18). A needs survey of different NYC communities served by the HHC agency was conducted by the HHC nurses, who were familiar with the specific communities and were able to identify the linguistic needs of the residents including primary language(s) of the residents (i.e., Spanish, Mandarin, Cantonese, Russian, and Ukrainian).
The survey identified two gaps in the communities that needed to be addressed in order to implement a linguistically competent Influenza Initiative. The gaps identified were (a) linguistic disparities that exist between nurses and residents in NYC communities, and (b) the need to provide culturally appropriate and linguistically competent care. In order to address and meet the needs of the residents for the initiative, dialogue between a school of nursing (SON) faculty member and Director of the HHC agency began. Hence, a joint collaborative effort was initiated.
Both the faculty member of the SON and Director of the HHC agency identified that the initiative would provide an opportunity for undergraduate nursing students to address the linguistic needs of the residents while enhancing their nursing skills. In the Fall of 2006 the first joint Influenza Initiative between the SON and HHC agency took place where undergraduate nursing students provided culturally appropriate and linguistically competent care in conjunction with HHC nurses.
Assessment Phase
As reported by the New York City Department of City Planning (NYC-DCP, 2004) the 2000 U.S. Census Bureau noted that the NYC population totaled 8 million people, 40% of the New York State (NYS) population. Of the 8 million, 2.9 million (36%) were foreign-born. In addition, the report indicated that in NYC there were approximately 170 different languages spoken. These demographic data demonstrate the diversity of the residents in NYC and supports the importance and need for providing culturally appropriate and linguistically competent care.
Healthy People 2010 asserts that "efforts are needed to develop and disseminate culturally and linguistically appropriate health information to overcome the cultural differences and meet the special language needs of these population groups" (U.S. Department of Health and Human Services, 2000, pp. 7-24). Given that the nursing students reflected the diversity of the residents of NYC, the students were the ideal group to meet the linguistic needs of the communities. In 2006, the ethnic demographic breakdown of the undergraduate nursing student population was as follows: Asian or Pacific Islanders (38%), Black non-Hispanic or African American (19%), Hispanic or Latino (9%), and White non-Hispanic (34%) (Aponte & Nickitas, 2007). The cultural and linguistic diversity of the students, many of whom were either bilingual or multilingual (i.e., Spanish, Chinese [Mandarin and Cantonese], and Russian) indicated that the students were vital in meeting the linguistic gap within the NYC communities and a vital asset for the success of the Influenza Initiative. Hence, pairing the findings of the needs survey and the cultural linguistic diversity of the nursing students provided a unique opportunity to collaborate and complement each other in meeting the needs of NYC residents.
Planning Phase
Once the needs of NYC residents were identified, the next steps entailed planning the Influenza Initiative. The influenza vaccination was being offered on different days and at different sites throughout a 3-month period. Essential components of planning the initiative included (a) identifying locations for the initiative, and (b) recruiting nursing students for the initiative. The HHC agency identified community centers as the locations where the initiative would take place. Given that the initiative (immunizations and education) was being offered in community centers located in areas where the HHC agency provided homecare services, residents of those specific communities were familiar with the agency and HHC nurses creating a nonthreatening environment. To notify the residents of the initiative, postings of the specific date and times were placed at the centers.
The SON faculty member extended an invitation to all undergraduate nursing students to volunteer for the Influenza Initiative and distributed a master list to the students for them to review and sign-up. To ensure the linguistic needs of the residents were met, the master list not only had the locations, times, dates, and approximate number of people expected, but also the primary language(s) of residents and number of nursing students needed, in an effort to match the additional language(s) spoken by the students and the primary languages of the community residents. The students were informed that upon participating in the initiative they would receive a "Thank You" letter demonstrating their participation, which they could include in their portfolio as one of documents demonstrating their professional development (Rassin et al., 2006). Approximately 20 students volunteered their services during each of the 2 years (Fall 2006 and Fall 2007) the Influenza Initiative has occurred.
The role of the nursing students included meeting, greeting, educating and translating for the residents of the community, while working with HHC nurses who administered the influenza vaccination. Nursing students were partnered with HHC nurses in order for students to further develop their assessment skills (i.e., history taking) and practice providing health education and disease prevention activities (i.e., teach sign and symptoms of influenza, importance of yearly vaccination), while meeting the linguistic needs of NYC residents.
Implementation Phase
The SON faculty member and Director of the HHC agency had continuous verbal and electronic communication during the planning and implementation phases of the student's participation in the Influenza Initiative. The students contacted the Director of the HHC agency a week before their scheduled date of the Influenza Initiative to gather information regarding attire and any additional instructions not previously mentioned, and/or changes.
On the day of the initiative the nursing students wore the HHC community health colors of a white shirt and blue pants in addition to their SON student identifications. The nursing students arrived one hour early to meet the HHC nurses and receive any final instructions before beginning "The Influenza Initiative." The HHC nurses organized the students' assignments, monitored, supervised and were available to troubleshoot any issues that arose.
Nursing Framework
The conceptual framework utilized for the Influenza Initiative in NYC was Orlando's Dynamic Nurse-Patient Relationship (see Figure 1). Specific theoretical concepts had relevance to this project and appropriately describe the communication between the nursing students, HHC nurses and NYC residents as shown in Table 1.
Evaluation Phase
Meeting the Linguistic Needs
This collaborative effort between a public academic institution and a nonprofit HHC agency demonstrated that the linguistic needs of a diverse population could be met. The continuous dialogue between the SON and HHC agency throughout the different phases of the initiative were key in ensuring success. Foremost, the needs survey was an essential element in identifying the unmet linguistic needs and gaps existing within the NYC communities where the initiative occurred. Also, the partnership between the HHC nurses and the SON students was critical in facilitating effective communication with the NYC residents during the Influenza Initiative in a culturally and linguistically competent manner. This initiative enabled the nursing students to effectively reach out, assess, and ultimately meet the cultural and linguistic needs of NYC residents.
Over 2000 NYC residents arrived and participated in the Influenza Initiative in Fall 2006 and Fall 2007. Given that most students were competent in English and fluent in another language, most residents were able to fully engage in gathering and participating in the Influenza Initiative, learning about influenza and the importance of vaccination, since the usual language barriers to communication were eliminated, as planned.
Influenza Initiative Students Outcome
To assess the student's perspective of Influenza Initiative's, an Influenza Initiative Questionnaire (IIQ) was created asking the students to, "State three (3) individual objectives you achieved during this experience that you feel will help you professionally", and "Describe how each objective was met in this experience." The ISS was provided the students electronically prior to their scheduled date to participate. The students were instructed to return the questionnaire in a sealed envelope and place it underneath the SON faculty member's office door. The nursing students reported a high level of personal satisfaction for having participated in the Influenza Initiative. They also reported feeling positive about being able to transform the theoretical knowledge and technical skills learned in their fundamental nursing course (i.e., therapeutic communication, history taking, and assessment skills). The students indicated that the initiative had broadened their understanding of the importance of community related issues, enhanced their conceptual nursing knowledge, assessment skills, and technical skills. The nursing students also indicated that the initiative allowed them to better understand the importance of addressing the linguistic needs of a community.
Connor (2003) suggests:
Community-based education provides a vehicle for framing a new paradigm of student education and community health, and offers a clear pathway for advancing the Healthy People 2010 objectives. It provides opportunities for health professions educators to expand student learning of the determinants of health and health disparities, as well as skills in health promotion, disease prevention, communication, partnership-building, and advocacy (p. 10).
The SON faculty member in collaboration with the Director of the HHC are planning on making the Influenza Initiative a yearly teaching learning activity for all undergraduate nursing students in this specific urban public university, SON. A significant, goal directed collaborative relationship between a public SON and a nonprofit HHC provided an insightful opportunity for nursing students to have hands-on experience in community based wellness and disease prevention activities via the yearly Influenza Initiative.
Summary
The Influenza Initiative provided a unique learning opportunity for nursing students to participate in wellness and disease prevention activities, enhance their knowledge and skills in nursing, and provide culturally appropriate and linguistically competent care. The nursing students were provided an opportunity to establish new interpersonal relationships, as well as create partnerships with HHC nurses. Students expanded their understanding of the unique purpose of community/home healthcare nursing, and were a vital part of the success of the Influenza Initiative.
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