Peer Power

The year is 1988. Seeking fellowship and peer support, Filipino nursing students at San José State University in California begin to meet regularly to share their feelings about the issues and challenges they face as they work toward their BSN degrees. For many of the students, especially those who have recently immigrated to the U.S., cultural issues–such as overcoming language barriers, homesickness and adjusting to an unfamiliar cultural environment—are an especially important concern.

Through these peer discussions, the students quickly realize that their learning reaches beyond the classroom and clinical areas, challenging who they are and whom they need to become in order to be successful in their studies and their future nursing careers. The group is a safe place to “vent,” to receive support and to learn appropriate techniques for overcoming obstacles.

Flash forward to 1997. After nearly a decade of these informal group meetings, the Filipino Nursing Students Association (FNSA) at San José State University School of Nursing was officially formed—and it has become so successful that it has developed into a national model to help Filipino students at other nursing schools across the country unite and assist one another.

Each year, on the first Saturday in February, the FNSA holds a conference at San José State. The most important development to emerge from the 1999 conference was the decision to create a national organization for Philippine nursing students, with San José’s FNSA as the flagship chapter. As a result, the Philippine Student Nurses Association of America (PSNAA) was born, holding its own first annual conference in 2000.

Katherine Abriam-Yago, RN, EdD, associate professor and student retention coordinator at San José State University School of Nursing, is the faculty advisor involved in the creation of both the FNSA and the PSNAA. As a Filipino American herself, Abriam-Yago attended nursing school at the University of San Francisco with only a handful of other minority students. She always knew that she would use the wisdom she gained through her experiences to mentor other students from culturally diverse backgrounds through the difficult years of nursing school.

“My father used to tell me, ‘You will always be judged by the color of your skin, but your education will open doors for you. When you are involved in an important role, you must help others,’” she remembers.

Cultural Coping Strategies

Abriam-Yago is particularly proud of the FNSA’s success in creating an environment where Filipino students—who make up approximately 20-25% of the San José State nursing school’s student population—can come together to share their feelings, problems and advice. The students bond with each other as they work together to master the cultural and professional components that will help them become successful nurses. The group provides guidance and emotional support to help its members realize that they don’t have to travel this academic journey alone. In fact, they find that other students are facing the same issues, and together they discuss ways to resolve them.

Abriam-Yago first saw the need for a group like the FNSA 14 years ago when she developed and launched the San José State nursing school’s orientation program for new students. At that time, only 25% of the students were persons of color—a figure that has since risen to 75%.

Today, orientation sessions for incoming Filipino students are also a key part of FNSA’s support network. A panel of nursing undergraduates welcomes the new students to the nursing program, answers any questions they may have about what they can expect during their course of study and discusses strategies for becoming successful students. At this session, the new students are introduced to the FNSA, as well as other groups and associations that can provide peer mentoring and support.

As the students begin to settle into their nursing studies, they help each other master academic skills–such as time management, critical thinking and prioritizing—and overcome cultural obstacles that can interfere with the learning process. According to Abriam-Yago, some of the most common cultural challenges Filipino students face include adjusting to American communication patterns, learning to be assertive with authority figures and trying to balance the demands of their studies with the pressures of their traditional family responsibilities.

Because strong communication skills are such an essential component of a successful nursing career, language barriers can be a significant impediment for Filipino students who speak English as a second language. Not only must they learn the basics of American English, including idiomatic and slang expressions, they need to master nursing and medical terminology as well.

“Being able to articulate their needs is an important issue with Filipino nursing students,” says Abriam-Yago. “For example, they will respectfully say they understand [what they hear or read in class] when they really do not.” Sharing strategies to help each other identify their needs, become better communicators and integrate their new knowledge with their cultural background is the essence of the FNSA.

When students are just beginning to learn their future profession, they often have difficulty feeling confident enough to be assertive—and for Filipino students, cultural barriers can compound the problem. Because questioning what others say, especially those in authority, is not generally taught in Filipino culture, they must learn to balance respect with appropriate ways of speaking up on behalf of their patients’ interests, such as questioning doctor’s orders that they feel are incorrect.

FNSA members collectively address these issues by participating in group assertiveness training and leadership development activities. Additionally, Abriam-Yago and other professional nurses who are members of the national Philippine Nurses Association of America (PNAA) and the regional Philippine Nurses Association of Northern California (PNANC) act as role models to inspire the students and help them further boost their self-confidence.

“I have found that there is a stereotype that Filipino nurses are not competent enough or they cannot communicate as well [as other nurses],” says Kathleen M. Morales, current president of the FNSA. “I don’t think about that; I demonstrate that I am competent, that I can do what any nurse can do and that I am proud to be who I am.” In addition to her leadership role in the FNSA, Morales has been accepted into the Golden Key National Honor Society, has received several scholarships and recently completed an internship at the University of California at San Francisco (UCSF). She has decided to attend graduate school at UCSF to become a geriatric nurse practitioner.

Filipino culture’s strong emphasis on family values is still another factor that can complicate matters for students already struggling to handle the stress of a rigorous BSN program. Some students may be responsible for supporting members of their extended family back in the Philippines—for example, sending a relative to school or helping in the care of younger children and elderly family members.

Furthermore, if students fall behind in their studies or do not do as well as they had hoped, the disappointment can be painful and families can be harsh. “Filipino parents are very strict about education,” notes Morales. “I have heard of parents putting their children to shame because they received a B rather than an A. Or if the student fails a class, the parents get really upset and regard their child as a failure. You wouldn’t believe how many students are scared to tell their parents they failed.”

From the Classroom to the Community

Membership in the FNSA is open to all students, regardless of ethnicity. For example, a Caucasian or Hispanic nursing student who is interested in working with the local Filipino community may find it helpful to join the group, not only to find fellowship with other students but also to participate in the association’s community health and outreach programs. This gives them first-hand opportunities to learn more about Filipino health issues and the cultural nuances that can help them provide more culturally sensitive care.

These community health projects are an important part of the FNSA’s broader mission to improve the health of Filipinos living in the San José area (see “Students with a Mission”). “Our intention is not only to help one another [as students] but also to give back to our community by providing volunteer services to different community centers and associations around the Bay Area,” explains Morales. “Our mission is to better ourselves so that we may in turn benefit others.

“When the Filipino community sees Filipino nursing students, they are proud of their culture and feel a sense of security and comfort with us,” Morales continues, adding that some Filipino immigrants are fearful of seeking health care, either because of language barriers or a lack of trust in Caucasian health providers. Being able to work with student nurses who share their cultural heritage can do much to help these patients overcome their fears, she says. “And they can also speak their own language [with us], so they do not need to speak English.”

FNSA members have collaborated with the PNANC on projects such as blood pressure screenings, blood drives and health fairs. They also recently participated in a multiple sclerosis walk, a breast cancer walk and an Asian bone marrow drive. Of the latter project, Abriam-Yago says proudly, “I received a letter of thanks for our participation. We were able to recruit over 50 individuals to donate their bone marrow.”

Priming the Pipeline

Will the fledgling Philippine Student Nurses Association of America eventually become affiliated with the PNAA? It’s too early to tell, says Abriam-Yago, noting that the PNAA is still in the process of officially defining its relationship with the student group. In San José, however, its local chapter, the Philippine Nurses Association of Northern California, works closely with the FNSA to provide the students with mentoring and support, and to encourage them to join the PNANC when they graduate.

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According to PNANC President Araceli D. Antonio, RN, MS, “Our mission is to promote fellowship and unity among Filipino nurses, to foster a positive image and to provide activities that assist in the professional development of the Filipino nurse.” As part of that commitment, the association provides scholarships to deserving Filipino undergraduate and graduate nursing students.

In addition, the PNANC invites FNSA members to attend its board meetings, workshops, seminars and other educational events. It also offers assistance, such as registration discounts and help with travel expenses, to nursing students who want to attend the PNANC’s annual conferences and the national PNAA annual convention.

Participating in these professional networking events beyond the nursing school campus gives the students an invaluable chance to learn about future career opportunities and make connections with other Filipino nurses who can serve as mentors and role models. As Abriam-Yago, who brought a delegation of FNSA members, including Morales, to the 2001 PNAA convention in Chicago, puts it, “We’re preparing the next generation of Filipino nurses.”

 

Going National

In the three years since the FNSA first set its sights on expanding into a national organization for Filipino nursing students, it has been working to create sister Philippine Student Nurses Association of America chapters at other schools around the country. Currently, FNSA members are mentoring a group of students at the Rutgers University College of Nursing in New Jersey to help them start a chapter based on the successful San José model.

Abriam-Yago adds that the February PSNAA annual conferences at San José State provide an ideal forum for students nationwide to network with FNSA members and discuss issues and challenges involved in forming a chapter. The recently completed 2002 conference brought together some 65 students, most of them from other parts of California.

Are you a Filipino nursing student or faculty member who would like more information about the Philippine Student Nurses Association of America? The FNSA invites you to contact Kathleen M. Morales at kmmorales@hotmail.com or Katherine Abriam-Yago at (408) 924-3159, abriam@aol.com. Students who are interested in starting a PNSAA chapter at their school will need a faculty advisor to help them with the process.

Students with a Mission

The Filipino Nursing Students Association at San José State University has come a long way since its early days as an informal peer discussion group. Today, its mission statement includes the following ambitious goals:

Purpose:
To support and mentor Filipino nursing students and to promote the health of the Filipino community.

Functions:
1. To provide culturally sensitive information and resources to Filipino nursing students in the School of Nursing.
2. To promote mentorship and fellowship of Filipino nursing students.
3. To support and participate with other Filipino community and nursing organizations locally and nationally.
4. To participate in the planning, development and evaluation of health care delivery and policy making for Filipinos in the San José area.
5. To promote quality nursing care for the Filipino communities in the San José area.
6. To compile and maintain a Directory of the Filipino nursing students at San José State University.
7. To promote and undertake research that promotes the health of the Filipino population in the San José area.
8. To establish resources to support scholarships for Filipino nursing students.

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