When Dr. Sylvia Peña was still a teenager, her awareness of health disparities caused her to rethink her plans to study biomedical engineering in college and pursue nursing instead.
The pivotal moment that set her on this new path was when, while volunteering at a hospital reception desk, she witnessed a Spanish-speaking mother struggling to get help for her sick baby from English-speaking emergency room staff. Because Peña spoke both English and Spanish, she helped the mother communicate her baby’s needs.
“When you grow up in the Hispanic community, you see a lot of inequality without realizing it’s inequality,” she said, “and you learn that it can’t happen.”
Now an assistant professor of nursing at Marquette University, Peña has a renewed commitment to addressing the inequities that disproportionately burden Latinos with their health, including language barriers, lower rates of health insurance coverage, and dietary and living conditions that increase the risk of developing diseases like diabetes and kidney failure. Supported by grants from foundations that support her commitment to reducing inequities, she is putting critical resources and innovative strategies in place to address these challenges.
A prime example is Peña’s project, funded by a $50,000 grant from AARP (American Association of Retired Persons), to establish a community-focused, bilingual clinical training center for Marquette University nursing students dedicated to providing bilingual dietary instruction to a primarily Hispanic guest at the Milwaukee Christian Center.
Launched last fall, this unique clinical program ran for two semesters and involved 12 undergraduate nursing students in preventive health tasks, helping more than 450 area residents. The program complements the Milwaukee Christian Center’s food pantry, and center leaders realized they needed culturally competent education to ensure guests wouldn’t struggle to turn their food choices into healthy meals.
To be sure, more than general nutrition education was needed: Many food pantry clients best understand medical instructions and recipes written in Spanish, and most specifically needed ways to adapt the traditional ethnic foods they know and love to reduce their risk of diseases like diabetes and cardiovascular disease.
The program features nursing students, who spend one day a week throughout each semester, typically six to eight hours at a time. Their first focus each week was on developing their education and therapeutic communication skills. After creating a nutritious recipe using items available in the pantry that week, the students present the recipe to the assembled guests, educating them on the effects of different ingredients on the body and specific health conditions. “During the presentation, one of my peers explained it in English, and then I translated everything into Spanish,” reports Marily Flores Carrillo, a fourth-year student who also created printed versions of the recipes in Spanish for guests to take home. “Education is an important role of a nurse, and clinical always gave me the opportunity to develop this skill.”
Care also regularly became more individualized: “My colleagues and I created different options for people with specific allergies or underlying conditions,” Flores Carrillo reports. “We began to think proactively about how every ingredient could add value to our recipes and make them delicious, nutritious, and culturally appropriate.”
Prior to working in clinical settings, students gained experience in the School of Nursing’s clinical simulation lab, working through care scenarios that involved educating and advising a prediabetic patient who only speaks Spanish.
We’re thinking about how we can make an impact outside of the hospital to prevent people from being hospitalized.
Dr. Silvia Peña
From Peña’s perspective, the benefits of this clinical trial are twofold. The first is the experience that MCC guests have. “We’re thinking about how we can make an impact outside of the hospital to prevent people from being hospitalized,” she says.
The second benefit was experienced by the students: With the guidance of their instructors, they learned to “think critically about disease processes like diabetes and hypertension and the impact of nutrition,” she says. The clinical placement also provided an important opportunity for students to build on the therapeutic communication strategies, intercultural competency and humility skills they learned in their first year of nursing. “By thinking critically and incorporating what we learned in our first-year courses with the people we worked with at MCC, we were able to avoid offering a one-size-fits-all health education model,” Peña says.
Peña is compiling data about bilingual clinical settings to help develop a study on the initiative, which will be presented this summer at the annual conferences of the National Hispanic Nurses Association and the International Society for Clinical Simulation Learning.
The Community Health Clinical Program dovetails well with other projects Peña leads that focus on reducing health disparities in Latino communities, including a Healthy Americas Foundation-funded study investigating why Latino women have lower cervical cancer screening rates, which translates into higher cervical cancer diagnosis and death rates in that same population. Selected for the grant along with 20 other researchers studying the issue across the U.S., Peña and her team have recruited 150 participants from the Milwaukee area for the study, which is currently in the data analysis phase.
“I’m passionate about addressing these inequities,” she says.
More broadly, that passion also includes equipping Latinas with the qualities and capabilities to become nurses, healthcare professionals and health educators. “When I was in nursing school, I didn’t have any Latina professors that looked like me until I got to graduate school,” she recalls.
As one example, this issue of limited representation emerged this spring as a factor in the project team losing an opportunity to extend their clinical training at the Milwaukee Christian Center for an additional year.
“Unfortunately, we were unable to find a bilingual clinical preceptor for the following year who could bridge the language barrier between the community and the students,” Peña said.
But for Flores-Carillo and the other students in the program, the clinical experience remains valuable. She recalls honing her therapeutic approach by making eye contact, asking questions, and paying attention to her tone of voice and posture as she met with MCC clients each week. “All of this had a huge impact on building trust. Many people were willing to open up about their lives, and some even saved a seat for me at lunch,” she recalls. “I used my therapeutic communication skills to become a trusted student nurse.”
