A Model for Educating Minority Nurses

1. A Model for Educating Minority Nurses Substance Abuse and Mental Health Services Administration Minority Fellowship Program at the American Nurses Association

2. Purpose • Discuss: Culture, Ethnicity, & Race • Present Data on Workforce Issues • Discuss the MFP as a Model for Diversity • Present Three MFP Fellows • Introduce the MFP Staff

3. Three MFP Fellows • Barbara Dahlan, Loyola University, Chicago • Donna Grandbois, North Dakota State University, Fargo • Mary Black, University of Minnesota, Twin Cities

4. MFP Staff • Janet Jackson, Program Manager • Judy Jones-Terry, Program Assistant

5. Significance • Health Disparities have an extensive history • Disparities are burdens of minorities • Minority persons are missing in the healthcare professions • Disparities are imbedded in differences in • income, • access to information, • cultural traditions, & • social structures Davis, 2003; Byrd & Clayton; IOM, 2993

6. An Expanded View of Disparities Infectious Disease Uninsured Severe Levels Of Distress Poor quality of life Maternal/ Infant Deaths Literacy Nutrition Crime Victims Injuries & Accidents Sickle Cell Low Birth Weight Babies Criminal Justice Sentencing Diabetes Juvenile Delinquency Housing & Homelessness Cardiovascular Disease Periodontal Disease Political Office Voting HIV Asset Accumulation Environmental Pollution Alcohol Abuse Cancer Obesity Graduation Rates Low Income Cocaine Use/Sale Mental Retardation Schizophrenia Depression Bipolar Domestic Violence Homicides Personality Disorder Dementia Capital Punishment Farm Work Unemployment Davis, 2003; Byrd & Clayton; IOM, 2993

7. Overlap in Three Domains Variables that Impact Healthcare Patient Provider System IOM, 2003; Sullivan Commission, 2004

8. Integrated Model of Healthcare Disparities Unequal Treatment, IOM, 2003, p. 127

9. Cultural Diversity & Health • Cultural Diversity will improve the quality of care for all people in the nation; • Culturally sensitive care, research, and public policy issues are domains that have the potential of helping to reduce and eliminate disparities among ethnic minority groups, and underserved Caucasians.

10. Cultural Diversity • Cultural Competence is essential for building consensus among people from different ethnic and cultural groups, communicating with families, making clinical decisions, etc. • Cultural differences are reflected among the three domains in health care: patient, provider, and systems • Historical perspectives should be understood and addressed as related to centuries of minorities’ underrepresentation in health professions; they experience poorer care, & higher mortality/morbidity than Caucasians

11. Power Terms in America • Race: Traditionally thought to refer to a biological phenomenon; it serves to help categorize persons based on some basic physical characteristics such as skin color, the texture of one’s hair, or the shape of one’s eyes, nose, and so forth. • No physiological evidence for categorizing people based on these characteristics. Bushmen in Southern Africa have epicanthic eye folds just as the Asian populations(Owens & King, 1999; Mental Health Report, 2001).

12. Power Terms • When race is used as a social concept, it becomes a forceful and potent phenomenon, determining who gets what goods and services, what groups are considered superior while others bear the burden of being perceived as inferior. • Race also helps to determine access to power, and what constitutes high and low status (Clayton and Byrd, 2002).

13. Power Terms Ethnicity: Describe common heritages, behaviors, values, perceptions, and folklore of a particular people. Music, language, food preferences, rituals, celebrations, and health beliefs and practices are typically explained with this concept. (Owens & King, 1999; Mental Health Report, 2001).

14. Power Terms • Ethnicity: Asian American, can refer to individuals from some 30 or more countries, or Arab Americans could include 25 countries; individuals and families in each of those countries have distinct heritages. • Hispanics are categorized as a particular ethnicity, not a racial group. (Owens & King, 1999; Mental Health Report, 2001).

15. Power Terms • Ethnicity: Hispanic ethnicity expands numerous groups, including Cubans, Guatemalans, Mexicans, Puerto Ricans, and others. • Some Hispanics are of African descent, while others are not (Mental Health Report; Schwartz,2001).

16. Power Terms Culture: This concept involves shared meanings among a group of people that are learned ways of thinking and the acquisition of worldviews. Cultural ties extend beyond race and ethnicity, and can include being Southern Baptist, or Catholic, or Muslim, or gay, Hispanic, or a Floridian or Ohioan.(Mental Health Report; Schwartz,2001).

17. US Population Profile Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. ( 2000).

18. U.S. Census Bureau, Census 2000; Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, p. 55.

19. U.S. Census Bureau, Census 2000.Mental Health Report, 2000, p. 108.

20. Census Bureau, Census 2000; Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, p. 108.

21. American Indian/Alaskan Native Populations by Region. http://www.Indians.org/Resource/FedTribes99/fedtribes99.html

22. U.S. Census Bureau, 1996, Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, Current Population Reports, P25-1130, Washington, DC.

23. Per Capita Income By Ethnicity in 1999 Per Capita Incomes African Americans $14,397 Asian American $21,134 American Indian Not Available Hispanic American $11,621 White American $24,109 Source: Mental Health Report, 2000, p. 39; U.S. Census Bureau, Current Population Reports, Money Income in the U.S., 1999. US Dept of Health & Human Services (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health. A Report to the Surgeon General. Rockville, MD, P 39.

24. US Nursing Workforce Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. ( 2000).

25. Workforce Issues • African Americans, Hispanics, and American Indians are missing in medicine, nursing, & dentistry(IOM, 2004; Sullivan Commission, 2004) • Nursing • 2.2 million employed • Physicians • 6000,000 • Dentists • 153,000(IOM, 2004; Sullivan Commission, 2004)

26. Workforce Issues • In Medical and Dental school populations, Asians are overrepresented, but in Nursing, underrepresented(IOM, 2004; Sullivan Commission, 2004) • Diversity across an ethnic groups must also be considered (Asian/Pacific Islanders [Hmong, Laotian, Cambodian, Malaysian, & Native Hawaiian, Pacific Islander people] are not overrepresented in the health professions)(IOM, 2004; Sullivan Commission, 2004)

27. Health Professions Profile • Ethnic minorities represent about 25% of the population of health professionals • Among health professions • Nursing: Less than 9% • Medicine: About 6% • Dentistry: About 5%Sullivan Commission, 2004

28. US Nursing Workforce • Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. ( 2000). Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. ( 2000).

29. US Medical SchoolClass of 2007 Expected Number to Graduate 16,0000 American Africans, Hispanics, and American Indians 2, 197 Nursing and Dentistry mirror medicine in this regardSullivan Commission, 2004

30. MFP:A Model 1970: The Center for Minority Group Mental Health Programs was established at NIMH after two years of discussions with African American Psychiatrists about mental health, workforce issues, ethnic minorities, cultural competence, and other related phenomena.

31. MFP: A Model 1974: Five MFP initiatives were established Nursing, Psychiatry, Psychology, Social Work, & Sociology

32. MFP: Model for Change • 1974-1996 • Ethnic Minority Fellowship Program was funded by the National Institute of Mental Health • 1977-2004 • Center for Mental Health Service, later SAMHSA funded Fellow

33. MFP: Model for Change • Five Minority Fellowship Programs • Nursing • Psychiatry • Psychology • Social Work • Sociology

34. MFP: Model for Change • Objectives of the MFP • Improve the delivery of mental health and substance abuse services to all ethnic minority populations • Increase percent of Ethnic Minority Nurse Leaders in Nursing Education, Policy, Practice, & Research • Educate the Next Generation of Nurses

35. Change • Develop mechanisms to regularly establish research priority areas. • Foster collaboration among researchers on issues of health disparities. • Evaluate the impact of existing interventions and research methods and tools designed to eliminate health disparities. • Publish and disseminate research information in ways that are meaningful to diverse audiences. • Facilitate mentoring of ethnic minority researchers in health disparities.

36. Model for Change

37. MFP as Model for Change

38. MFP as Model for Change

39. Action? • Responsibilities of stakeholders (society, government, schools of nursing, medicine, dentistry)? • Formal evaluation of cultural competence in education programs, clinical practice, and research? • Increased research about health disparities in health care and health status of ethnic minority populations including: racial biases and stereotyping; communication effectiveness; interventions for improved health behaviors among vulnerable populations; help seeking behaviors among ethnic minority populations, and so forth(Smedley, 2003; Byrd & Clayton, 2003; Sullivan Commission, 2004; IOM, 2004) • What about the over reliance on standardized testing, or the unsupportive cultures within institutions, or leadership that has no demonstrated commitment to diversity?(Smedley, 2003; Byrd & Clayton, 2003; Sullivan Commission, 2004; IOM, 2004)

40. MFP: Model for Change Key Elements of MPF • Connection with National Organization, ANA • Support • Mentoring • Academic Guidance • Protects against Isolation and Alienation • Incubator of Ideas about Research, Practice, & Policy • Linkage with National Issues at SAMHSA & ANA • Potential for Local, State, National & International Leadership

41. Thoughts about Change • Address the pipeline causes/issues • Support alternative education models • Focus on continuing education • Provide training via technology • Bundle licensure and cultural competence • Bundle Cultural Competence with accreditation • Bundle federal research support to Cultural Competency • Provide federal incentives for retraining • Support development of model curricula Davis, 2003

42. Summary • The MFP has established the reputation of being one of the most effective programs for educating ethnic minority nurses. • It has been an integral component of the academic landscape in the five disciplines for more than 30 years.

43. MFP: A Model for Change • The MFP has supported more than 10 American Indian nurses to attain their PhD Degrees. • The immediate goal is to recruit and retain Alaska Native Nurses and strengthen relationships with all ethnic minority nurse organizations.