It's a challenge to help nurses get the clinical and multicultural skills they need to care for today's diverse patient population. Fortunately, Carol Holtz, RN, Ph.D., is an educator ahead of her time.
Holtz, a professor at Kennesaw State University's WellStar School of Nursing, launched a nursing practicum in Oaxaca, Mexico, 11 years ago. Since then, both the program and the need for it have grown. So has Holtz's reputation as a "go-to" person for international health initiatives and information.
The idea for an immersion program came to Holtz as she watched nursing students at Grady Hospital struggle to care for Hispanic patients and saw some of their negative attitudes about patients who couldn't speak English.
"Madeleine Leininger, the founder of transcultural nursing theory, believed that it was not the client's responsibility to be understood, but the nurse's responsibility to understand and meet the client's needs," Holtz said.
With the United States experiencing a large, sustained immigration wave, Holtz knew nurses need to think outside of their own cultures. While cross-cultural training and language skills could be delivered on campus, Holtz thought it would be more effective and fun to take students to Mexico to learn those skills.
"I was so excited, I wrote the syllabus in one night," she said. "I didn't want to take students to a tourist resort where people spoke English. I wanted a place with rich culture, where nurses could learn more about health and have fun."
Holtz built on an existing relationship between Kennesaw State's international studies department and the University of Oaxaca's Centro de Idiomas language center, and met with the secretary of health of the state of Oaxaca to explain her plan.
"He wanted to know why we were coming, what we wanted to accomplish and would our students expect to be paid?" Holtz said. "The government was afraid that we had a hidden agenda, but when I assured them that we were only here to learn and share and that our students would be bringing supplies with them, he agreed."
Holtz has had to resell the plan many times over the years, as new government officials have been appointed, but it's gotten much easier for her. "My Spanish-language skills have improved over the years, and so has the government's level of trust," she said.
As part of a faculty exchange, a master's-degree-prepared nurse educator from Oaxaca will begin teaching at Kennesaw State in January.
For two weeks each summer, Holtz takes 12 to 16 students to live and work in Oaxaca. Each student lives with a host family, which provides a bedroom, shared bath and meals and which treats them like family while they are visiting.
The students work at an inner-city hospital and a specialized pediatric hospital with local nurse mentors and make house calls with doctors.
Sharing knowledge
"Although our health care system is more sophisticated, we are not in control here. As long as it doesn't hurt anyone, we follow their protocols," Holtz said. "The hospital administrators tell us that our students have excellent skills. When nurses and students grow comfortable with one another, they share ways of doing things and experiences.
"We're not there to change their system, and we can't take medications into the country, but we all take suitcases of donated disposable gloves, syringes, alcohol wipes, thermometers, stethoscopes and other supplies."
On the weekends, the group goes sightseeing at the Zapotec pyramids of Monte Alban and visits local villages to experience the unique black pottery, weaving, dance and music of the area. Holtz tries to keep the practicum cost to about $2,000 per person, which includes tuition for the three-hour credit course, airfare, room and board, and all excursions. Some partial scholarships are given.
In the beginning, Holtz had to really push the program and accepted pre-med and social work students to fill out the numbers, but in recent years, she has had no trouble recruiting nursing students from Kennesaw State and other schools.
"They actually get more clinical contact hours than they would at home. They learn a lot of skills and things they won't find in a textbook," she said. "Many say that it's more than a course. It's a life-changing experience.
"What our students gain is respect for another culture. They're surprised that the health care professionals can do so much with so little."
The students often are emotionally touched by the open welcome they receive and are impressed by how few supplies are wasted. Disposable gloves are washed and reused. IV fluid bags are used to support a patient in alignment, while supply boxes are used as containers.
Afterward, the students are required to write journal summaries culled from their daily journal entries and must compose a formal research paper on major health issues identified by the Oaxacan community.
"The students often don't realize how much they've learned about the culture, the language, themselves - about being flexible and adaptable as health care providers - until they get back and reflect," Holtz said.
Holtz sees a difference in the confidence level of returning students. They also are more comfortable talking with Hispanic patients.
"Their attitude is different, and I hope that they'll model that difference for others and that it will spread," Holtz said. "The number of Hispanic patients is increasing - this is our world - and communication and respect are key in caring for these patients."
While the program takes enormous preparation time, and Holtz is on call 24/7 to students during their stay, she enjoys the bonding that occurs.
"I get back everything I put into it and more," she said. "Part of the point of being a teacher is to also be a mentor. I had an idea, took a risk and many things have come back to me as a result. It was a very good decision."