The Benefits of Being Bilingual: Breaking Down Language Barriers

The Benefits of Being Bilingual: Breaking Down Language Barriers

Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to the woman in her native language to determine why she was reluctant to take her medicine.

“Like many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.”

Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions.

As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million); and Korean (1.1 million).

Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap.

Because factors such as language, unfamiliar customs, and misconceptions about health care can keep foreign residents from seeking medical care, bilingual nurses can help to ease a patient’s fears and even reduce barriers to clinical preventative care.

There are also professional benefits to learning another language: Some bilingual employees can earn more than their single-language colleagues.

Providing Culturally Sensitive Care

Jimmy Andres Reyes, RN, MSN, DNP, AGNP, of Cedar Rapids, Iowa, an instructor in advanced practice nursing with Kaplan University School of Nursing and the dean of nursing at Kirkwood Community College, says he was inspired to become a nurse after watching the work of his grandmother, who was a community health nurse in Santiago, Chile.

Five years ago, Reyes received a predoctoral scholarship award to study diabetes self-management in Latino older adults.  Fluent in both Spanish and English, Reyes says that being bilingual allowed him to hold focus groups in Spanish that helped staff determine the stressors and barriers that prevented the patients from keeping their diabetes under control.

“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes. “For them, it was simply easier to be cordial, but as a result, they weren’t learning the tools and information needed to manage their diabetes.”

Reyes and his colleagues were able to take the information gleaned in talking with Latino immigrants and to pilot several programs. The information they gathered was not only translated into Spanish, but also designed to be culturally sensitive and relevant.

Reyes also believes that nurses can learn about different cultures through medical missions and studying abroad. He recently accompanied a group of nursing students to Costa Rica and plans to take another group to Ecuador later this year.

“Traveling to Costa Rica changed the world view of all of our students, and even those who didn’t speak Spanish returned to the US with a better understanding of the health care barriers and challenges that many immigrants face,” says Reyes.

As a bilingual nurse educator, Reyes believes his job in providing culturally sensitive care isn’t to change the beliefs of his patients, but rather to provide them with all of the facts they need to manage their condition.

“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with the information to make an informed decision.”

Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population.

“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”

Addressing Patients’ Unique Cultural Beliefs and Concerns

Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect.

“According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.”

Varughese notes the tea needed to be prepared in a special way and was very important to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care.

“Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.”

Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all non-medical patient requests.”

Nenette Ebalo, RN, has found that her ability to speak Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as service unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing.

“As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.”

Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking with Ebalo in Tagalog, they asked if she could accompany them to their appointment. After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given.

“They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo.

In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad.

“I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”

Breaking Communication Barriers

Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job.

“Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use electronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.”

In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with.

“Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was running late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.”

Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.

Becoming a Certified Medical Interpreter

While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally.

Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity.

Tuerk enrolled in the three-day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws.

“The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.”

 

The Forefront of Cancer Treatments and Lingering Disparities

The Forefront of Cancer Treatments and Lingering Disparities

Despite advances in recent years relating to cancer prevention, detection, and treatment, many minority groups in the United States continue to bear a greater cancer burden than whites.

According to the National Cancer Institute’s Center to Reduce Cancer Health Disparities, while one in three Americans will develop some form of cancer, it continues to be the number one cause of death for many minorities in the United States.  Nationwide, African Americans have a higher rate of death from cancer than Caucasians, and cancer has surpassed heart disease to become the leading cause of death among Hispanics and Asian Americans in the United States.

While the statistics are sobering, researchers say minority nurses can play an important role in working to reduce cancer disparities in their communities.

“Nurses are at the forefront of care and can have a major impact in eradicating cancer disparities by educating patients about the importance of cancer screenings, early detection, and access to care,” says Kimlin Ashing-Giwa, PhD, professor and director of the City of Hope’s Center of Community Alliance for Research and Education in Duarte, California. Ashing-Giwa’s work focuses on addressing the disparities in treatment and outcomes between patients with different access and cultural approaches to medicine.

How Breast Cancer Affects African American and Latina Women

“Although African American women are less likely than white women to be diagnosed with breast cancer, they are more likely to be diagnosed at a later stage and to die of their disease,” says Ashing-Giwa. “Despite the decline in overall breast cancer death rates in the past 20 years, black women continue to have higher death rates.”

A 2012 report from the Centers for Disease Control and Prevention (CDC) says that mammography may be used less frequently among black women than white women. It’s also more common for a longer amount of time to pass between mammograms for black women. Additionally, Ashing-Giwa notes that African American women commonly have subtypes of tumors that are harder to treat, especially an inflammatory form called triple negative breast cancer.

The CDC report also stresses the importance of educating women about the preventive benefits and coverage provided by the Affordable Care Act, including coverage of mammograms without co-pays in many health plans and, beginning in 2014, expanded access to health insurance coverage for 30 million previously uninsured Americans.

“Additionally, a woman’s best overall preventative health strategy is to reduce her known risk factors for breast cancer as much as possible by avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake,” says Ashing-Giwa, who encourages nurses to talk to patients about their risk of breast cancer and the importance of getting mammograms and doing breast self-exams.

If women can’t afford a mammogram, there are many free resources available that nurses can recommend to patients (see sidebar). In addition, black women are less likely to get prompt follow-up care when their mammogram shows that something is abnormal. Waiting longer for follow-up care can lead to cancerous tumors that are larger and harder to treat.

Follow-up care after mammograms is also a problem for Latinas. “While Latinas have lower incidences of breast cancer than white or African American women, breast cancer is the leading cause of cancer death for Latinas,” Ashing-Giwa says.

A March 2013 study conducted at the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio and published in SpringerPlus found that it took Latinas 33 days longer to reach definitive diagnosis of breast cancer than non-Hispanic white women.  Researchers found that Latinas with abnormal mammograms benefitted significantly from the help of trained professionals called “patient navigators,” who were trained in providing culturally sensitive support. Patient navigators were also helpful in providing transportation, language, and childcare solutions.

“We need to move toward more prevention, screening, treatment, and follow-up that speaks to people in a language they understand,” says Ashing-Giwa.

Despite Being Preventable, Disparities Still Exist With Cervical Cancer

Kimlin Ashing-Giwa by Walter UrleAlso of concern are the large differences in rates of new cases and deaths from cervical cancer among African American and Latina women. “Latina women have the highest rates of cervical cancer, followed by African American women,” says Ashing-Giwa. “This is troubling because most cases of cervical cancer are largely preventable and treatable with regular Pap tests and follow-up.”

Mortality rates are also higher for women over 50.

“Many women believe that since they are single and not sexually active, they don’t need a Pap test,” Ashing-Giwa says. While stressing the need for older women to get regular Pap tests, she notes it’s also important for nurses to encourage younger women to get the human papillomavirus (HPV) vaccine and to use condoms. HPV infection is the leading cause of most cervical cancers.

“Cervical cancer should have been eradicated 30 years ago with the invention of the Pap test,” argues Ashing-Giwa. “Most women who are diagnosed with cervical cancer today are those who have never been screened for it.”

Minorities Less Likely to Get Screened for Colon Cancer

A 2012 study conducted at the Center for Health Policy at the University of Nebraska Medical Center College of Public Health and published in the public health journal, Health Affairs, found that minorities are less likely to be screened for colon cancer. The data revealed that 42% of Caucasians were screened for colorectal cancer, compared with 36% of African Americans, 31% of Asian and Native Americans, and 28% of Hispanics.

“The death rate for colon cancer has increased among African Americans and Hispanic people despite it being one of the most preventable forms of cancer, and if caught early, one of the most curable,” says Durado Brooks, MD, MPH, director of prostate and colorectal cancers for the American Cancer Society.

“Although many people of color are aware of colon cancer, they don’t always see how it applies to them,” says Brooks. “If they don’t have a family history of the disease or have symptoms, such as blood in their stools, they often don’t see the need to be screened.”

Only 10% of colon cancer cases are tied to family history, and by the time warning signs are apparent, the cancer has often progressed to an advanced stage where it’s harder to treat. And while it is currently recommended that regular colon screenings begin at the age of 50, it’s recommended that screenings for minorities begin at 45 since many colorectal cancers have been caught in African Americans and Hispanics at younger ages.

“Many people are unaware of the benefits of colorectal screenings,” says Brooks. “There’s the perception that cancer is a death sentence, yet up to 90% of colon cancer cases are preventable with screening.”

Brooks praises Kaiser Permanente for being proactive about screening its health plan members for colorectal cancer. “Rather than waiting for people to ask to be tested, Kaiser Permanente sends out fecal immunochemical testing kits, a type of fecal occult blood test, in the mail to their members who are 50 and older,” Brooks says. “Not all health care providers are as proactive with their approach.”

And while colonoscopies are still considered the gold standard for detecting colorectal cancer, they also require rigorous preparation—a point that prevents many people from getting tested. In an effort to increase testing for colon cancer, Brooks notes that it’s important to let patients know they have choices and that there are other screening options available.

A study published in the April 9, 2012 issue of Archives of Internal Medicine confirmed this by noting that patients were less compliant with screening for colorectal cancer when colonoscopy was the only option offered. Yet when patients were given a choice between a colonoscopy and fecal occult blood testing, 69% completed one of the two exams.

Latino Men at High Risk of Prostate Cancer

According to the American Cancer Society, prostate cancer is the most commonly diagnosed form of cancer among Latino men, and they are also the most likely to be diagnosed with later-stages of the disease.

A new study conducted by researchers at the University of California—Los Angeles (UCLA) and published in the March 2013 issue of Qualitative Health Research concluded that a combination of financial, cultural, and communication barriers play a role in preventing Latino men from accessing the care and treatment they need.

“These obstacles require a new focus on not only adequate health care coverage, but also on the array of hurdles that limit patient access,” says Sally L. Maliski, PhD, RN, FAAN, associate dean for academic affairs at the UCLA School of Nursing and senior author of the study.

Moon Chen Jr., PHD, MPHMaliski cites inability to afford medical insurance, difficulty understanding insurance policies, a lack of health literacy among the men, and their limited proficiency in English as barriers throughout the entire prostate cancer-care process.

“Our findings made it clear that we need a system where not only is care affordable, but where we use a multi-faceted approach to improve access, increase health literacy, and greatly improve care coordination,” says Maliski.

Focusing on Cancer Disparities in the Asian Community

“The cancer burden in the Asian American community is unique because cancer has been the leading cause of death among Asian Americans for the past 13 years,” saysMoon Chen, Jr., PhD, MPH, principal investigator for the National Center for Reducing Asian American Cancer Health Disparities headquartered at the University of California-Davis Cancer Center. Chen adds that hepatitis B induced-liver cancer is the greatest cancer health disparity for Asian Americans.

“All Asian American immigrants and their children should be screened for hepatitis B to lead to earlier detection,” Chen says. “And Asian Americans who do not have hepatitis B immunity should also get the hepatitis B vaccine, [which is] the best way to stop the spread of hepatitis B.”

Chen and his colleagues have received a federal grant to increase screening for hepatitis B. Since December of last year, screening events have been held in Northern California at Asian health clinics, local churches, temples, health fairs, and community organizations.

Many Asian Americans don’t get regular cancer screenings, which also adds to poor cancer outcomes. “Until they have symptoms, many Asian Americans aren’t really concerned about cancer and don’t think screening is necessary,” Chen says. “Vietnamese women have the highest rates of cervical cancer, which can be detected and treated early through Pap smears.”

Chen says cigarette smoking is also a big problem among Asian American immigrants and that they are the racial group least likely to be counseled on smoking cessation.

“Smoking is the leading cause of death worldwide and it’s a preventable risk factor,” Chen says. “It’s a complicated message and often language can be a barrier. There’s a great need for smoking cessation programs that are culturally tailored to Asian populations, both in language and intent.”

Stomach cancer is also prevalent in Asian Americans and Chen attributes this to chronic infection with Helicobacter pylori bacteria, which is common in developing countries. In Koreans, diet is also to blame, specifically foods that are preserved with nitrates and nitrites, such as kimchi.

Since prevention and early detection are key components of cancer control, Chen recommends that nurses who work with different Asian American populations either learn the specific language of their demographics, or have cancer education materials readily available in different languages such as Vietnamese, Korean, Mandarin, and Tagalog.

“Nurses who can accommodate differences in language fluency, dietary practices, and cultural beliefs can help to remove some of the barriers that exist in screening and treating minority patients,” Chen says. “Nurses who have this expertise are often the bridge between health care systems and minority communities.”

Following in Her Footsteps

Although it happened over 30 years ago, Henry Talley V, PhD, CRNA, MSN, vividly remembers the day he first met Goldie Brangman, CRNA, MEd, MBA, founder and director of New York City’s Harlem Hospital Center School of Anesthesia for Nurses.

“I was working as a nurse at Harlem Hospital and had met some of Goldie’s students from the anesthesia program,” he says. “I was so impressed with the work they were doing and the way they carried themselves that I immediately went to Goldie’s office to introduce myself and find out how I could enroll in her program.”

Talley remembers Brangman looking at him over the top of her glasses and asking if he understood the responsibilities of a nurse anesthetist. “Goldie is only 5 foot 2 but she always seemed larger than life,” he says. “When I told her I didn’t know much about nurse anesthetists, she told me not to come back until I did. The Internet didn’t exist [back then] so I did research at the library and read everything I could on the topic.”

After Talley completed his re-search, he returned to Brangman’s office. “I must have made an impression on Goldie, because she took the time to speak with me about how I could begin a career in nurse anesthesia,” he says. “I was a real inner city kid from the Bronx. That chance encounter with Goldie helped to save my life and proved to be the beginning of a career that I love.”

Today, Talley is the director of the nurse anesthesia program at Michigan State University College of Nursing and founder of Minority Anesthetists Gathered to Network, Educate and Train (M.A.G.N.E.T.). He is one of many minority CRNAs who credit Brangman with being not only their mentor but a pioneer who blazed new trails of opportunity for nurses of color and men in the field of nurse anesthesia.

An Inspiring Educator

In addition to her many contributions to the nurse anesthesia profession as an educator, author and clinician, Brangman was the first—and so far, only— African American president of the American Association of Nurse Anesthetists (AANA), serving from 1973 to 1974. Today, at age 92, she lives on the Hawaiian island of Oahu, where she remains active as a volunteer with the American Red Cross. She still attends the AANA’s Annual Meeting and keeps in touch with many of her former students, including Talley.

“Goldie is the greatest mentor any nurse could ever have,” he says. “She instilled confidence and pride in her students and taught us how important it was to become [actively] involved in our profession if we wanted to see change. With Goldie, failure was never an option.”

Talley took his teacher’s words to heart and went on to become the first African American to serve as director of a university nurse anesthesia program. He also plans to run for a national leadership position on the AANA board of directors.

“There are still not a lot of minority nurse anesthetists and I believe that’s due to a lack of awareness about the field,” Talley says. “Goldie encouraged her students to serve as role models. I’ve tried to follow in her footsteps and give back to a profession that’s been very good to me.”

Bobby Turner, a retired CRNA from Louisville, Ky., was one of Brangman’s students in the 1960s. He, too, continues to keep in touch with his former mentor. Turner says he was able to take many of the lessons learned in Brangman’s classroom and apply them in his own career.

“Goldie expected a lot from her students but she was also very supportive of us,” he adds. “She taught us that we needed to make pre-op rounds in addition to the anesthesiologist. Working in pediatrics, I found that introducing myself to children before surgery and talking to them about the procedure helped to ease their fears.”

Brangman also impressed upon her students the importance of becoming involved in the AANA. “I remember Goldie taking her students to the AANA national conference,” Turner says. “Now, even though I’m retired, I continue to attend the conferences every year.”

Finding Her Calling

Goldie Brangman graduated from Harlem Hospital Center’s nursing program in 1943 and went on to accept a nursing job at the hospital. But ironically, she was almost ready to give up on nursing as a career before finding her true calling as a nurse anesthetist.

Goldie Brangman (seated, center) with the 1974 graduating class of Harlem Hospital Center School of Anesthesia for Nurses. She founded the program in 1951 and directed it for 34 years.

“Right before World War II began, I had made the decision to leave the nursing profession,” she remembers. “I hated bedside nursing with a passion. At the time, black nurses were asked to do tasks that a white nurse would never have been asked to do.”

When the U.S. entered the war, many of Harlem Hospital’s phys-ician anesthetists were recruited for active duty. To fill the gap, the hospital began seeking volunteers to train as nurse anesthetists.

“The residents and surgeons trained us in all aspects of anesthesia,” Brangman says. “I really enjoyed the work. Unlike many nursing jobs, [in nurse anesthesia] you have a beginning and an end—you put the patients to sleep and you later have the satisfaction of seeing them wake up and begin the recovery process.”

When Harlem Hospital decided to establish a school for nurse anesthetists in 1951, the administration asked her if she would be interested in leading the program. Brangman welcomed the opportunity to open one of the first nurse anesthesia education programs in the country that boasted a diverse student body.

“There weren’t too many schools at the time that admitted blacks, men or students from foreign countries,” she explains. “We would hold dinners each weekend and try different foods representing one of our students’ diverse ethnic backgrounds.”

Because she believes anesthesia is a specialty that can’t be learned solely from a textbook, Brangman encouraged her students to gain real-world experience. “Working in the clinical field isn’t something my students would do only at the completion of the program,” she says. “I stressed the importance of learning how to take the pulse of a real person and of making pre-op rounds where they could introduce themselves to their patients [and get to know them].”

Integrating the AANA

In addition to her many achievements as director of the Harlem Hospital Center School of Anesthesia for Nurses (where she also held the positions of director of continuing education for the departments of anesthesia and respiratory therapy), Brangman was the first African American CRNA to break through barriers of prejudice to become a nationally recognized leader in her field. She was elected president of the New York Association of Nurse Anesthetists in 1959 and later served on AANA’s national board of directors—first as treasurer from 1967 to 1969, then as president in 1973-74.

“I was the first woman of color in a leadership position in the AANA, and as a result I had to run for every AANA office at least twice,” Brangman says.

She was also the first AANA president to give a theme to her presidential year, calling it the “Year of Communication.” During her term, she strived to achieve more open and effective communication between the AANA and its members, the public, legislators and other health care organizations. She also brought about some much-needed changes in the association’s organizational structure and management.

“Before my term as president, the AANA had been more [like] a social club,” Brangman says. “I accomplished my goal of making it more of a business.”

She remembers walking into the AANA offices at the beginning of her term and seeing membership dues sitting unopened in a basket. “One of the first things I did was hire a full-time bookkeeper.”

Despite the passage of the Civil Rights Act in 1964, Brangman says issues of racial inequality continued to exist in the nursing profession in the 1970s. “There were many times I would look around at the Annual Meeting and see only a sea of white faces. We were able to dramatically increase the number of male anesthetists in the AANA, but racial integration took much longer.

“We had a black CRNA [member] who lived in the South but was only allowed to attend national meetings, not those offered in her state,” Brangman continues. “I remember being asked to speak at a meeting in Alabama in the 1970s. When I walked in the front door of the hotel, almost everyone [just about] had a heart attack. Despite being the only black nurse at many meetings, I was determined to be there.”

Passing the Torch

After completing her presidential term, Brangman continued to provide innovative leadership to AANA in her capacity as past president. She introduced workshops on quality assurance and helped write the first AANA Quality Assurance Manual. In addition, she initiated the introduction of workshops on regional anesthesia (local anesthesia administered to a specific part of a patient’s body) at the AANA Annual Meeting and was one of the first educators to teach regional anesthesia techniques, both in her Harlem Hospital Center anesthesia program and at many state and national AANA meetings.

Today she sees a continued need for more minority nurse anesthetists to follow in her footsteps by taking on leadership roles within the AANA, serving as mentors and encouraging more nurses from underrepresented populations to pursue careers in anesthesia.

“The AANA hasn’t had another president of color since I served,” Brangman points out. “More minority [nurse anesthetists] need to run for leadership positions.”

Fortunately, Brangman’s inspiring presence is motivating a new generation of nurse anesthetists to follow her example of being a visible mentor and giving back to the profession. Nowadays, minority CRNAs such as Talley and Wallena Gould, CRNA, MSN, founder and chair of the Diversity in Nurse Anesthesia Mentorship Program, are carrying on her tradition.

Gould first met Brangman at an AANA meeting in 2003 and now considers her a mentor. “Until I met Goldie I didn’t know the AANA had once had a minority president,” she says. “She’s a true trailblazer and I can’t imagine everything she had to overcome to achieve all of the milestones in her career.

“I was a single mom working as an operating room nurse when I first met a black nurse anesthetist and learned about the profession,” Gould continues. “Several nurse anesthetists of color, including Goldie, had a great impact on my career. I believe it’s important to empower and mentor future minority nursing students through programs such as the Diversity in Nurse Anesthesia Mentorship Program.”

Coming Full Circle

Brangman’s lifelong commitment to increasing opportunities for nurse anesthetists has earned her some of the profession’s highest honors. In 1983 she received the AANA’s Helen Lamb Outstanding Educator Award. The association honored her again in 1995, presenting her with the Agatha Hodgins Award for Outstanding Accomplishment. The award, which bears the name of the AANA’s founder and first president, recognizes individuals “whose foremost dedication to excellence has furthered the art and science of nurse anesthesia.”

Although Brangman left her position as director of the Harlem Hospital Center School of Anesthesia in 1985 and moved to Hawaii to retire, she is still making a difference in people’s lives. Four days each week, she volunteers for eight hours a day as a health consultant to the Hawaii State Chapter of the American Red Cross. In many ways, her life has come full circle.

“As a student nurse in the 1940s, I was sent out with a tin can to collect donations for the Red Cross on the streets of New York,” Brangman says. “[When I moved to Hawaii I had planned on just being retired], but instead I was talked into volunteering. I’ve worked with the Red Cross in a number of different capacities for the past 69 years.”