Unfortunately, some issues or diseases are more prone to affect people in certain communities—case in point, colorectal cancer has been known to disproportionately affect the Black community as compared with white communities. In fact, according to the American Cancer Society, Black people are up to 20% more likely to get colorectal cancer and are also about 40% more likely to die from it.
We interviewed Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, academic coordinator for Walden University’s MSN-FNP program, as she has conducted research on colorectal cancer in men as well as Black men and women’s health issues, including disparity in health and health care.
Phyllis Morgan, PhD, FNP-BC, CNE, FAANP
Why does colorectal cancer disproportionately affect the Black community?
There are several reasons why colorectal cancer disproportionately affects the Black community. First, there is a general lack of knowledge about screening for colorectal cancer, which contributes to inadequate prevention and screening behaviors. There are also various fears that come into play, such as fear of cancer and of a cancer diagnosis, and fatalistic views about cancer.
A recent study showed that in Black Americans, the right side of the colon ages much faster than the left side, which could contribute to this population’s increased risk for colorectal cancer, particularly on the right side of the colon, and at a younger age.
Other factors may include delayed treatment and the fact that Black individuals have a higher incidence of obesity and more often consume a high fat, low fiber diet, which increases risk.
Why are Black people who get colorectal cancer about 40% more likely to die of it than other groups?
In addition to factors such as inadequate prevention and screening behaviors as well as delayed treatment, racial inequities in care also contribute to the fact that Black people who get colorectal cancer are more likely to die of it than other groups. There is a widespread lack of access to care for many people in this population, and some have no health insurance or inadequate health insurance for treatment.
Additionally, lifestyle factors such as diet and exercise can contribute to this.
What are the challenges facing the Black community regarding colorectal cancer?
Some challenges facing the Black community regarding colorectal cancer include inequities in health care, lack of access to quality care, and a lack of adequate resources to educate about the importance of colorectal cancer screening. It is crucial that we increase screening by providing better education for the Black community regarding screening and the importance of polyps being removed from the colon.
Additionally, we need more diverse health care providers, so patients can have providers who look like them and with whom they can connect and relate. Black health care providers can play an important role in helping patients to understand the seriousness of colorectal cancer in their community.
What can nurses do in order to get people in minority communities to go for tests, pay attention to symptoms, etc.?
First, nurses can help by providing more colorectal cancer resources for their communities. In addition, culturally appropriate educational programs and community or faith-based educational programs can be helpful in encouraging people in minority communities to undergo screening.
As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify ways to increase awareness, prevention, and treatment of health issues that impact the Black community. Specifically, I worked on a community and faith-based education program to increase awareness of prostate cancer among Black men, which resulted in an increase in participants’ general knowledge of prostate cancer and treatment by over 40%. I have also implemented successful community and faith-based education programs in North Carolina and Virginia to help educate Black people about colorectal cancer and increase screening behaviors. These types of programs are proven to make a difference.
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
Last but not least, Walden University and the National League for Nursing are excited to launch the Institute for Social Determinants of Health and Social Change, where nurse educators and inter-professional colleagues will play an instrumental role in achieving health equity across various demographics. The institute is designed to cultivate these health care professionals into leaders who address the impact of structural racism, socioeconomic status, environment, education, adequate housing, and food insecurity on health and well-being.
In minority communities, there have been a number of challenges with people not wanting to receive a vaccine for COVID. While we’ve already talked with someone about what is going on in the Black community, we also wanted to check in with the Hispanic community as well.
Norma Cuellar, PhD, RN, FAAN, is President of the National Association of Hispanic Nurses as well as the editor-in-chief of the Journal of Transcultural Nursing. She took the time to answer our questions about this.
Why are Hispanic communities not being vaccinated as the same rate as white people?
There are many reasons. One is the social determinants of health, like a lack of access to health care providers or lack of culturally congruent health care. The second is trust. Underrepresented or underserved communities often look skeptically on the health care system because of historic inequities. This leads to fears of adverse health outcomes, including side effects of the vaccine.
Regarding the vaccine, what are the challenges facing the Hispanic community?
A major issue is confidentiality, particularly as it relates to immigration status. Also, language barriers can be a significant roadblock, so there needs to be more communication in Spanish to help reach people that are otherwise left behind.
Are people in the Hispanic community hesitant to receive the vaccine to prevent COVID-19? Why or why not?
There is a spectrum of receiving a vaccine: from yes to no, and then the middle. Vaccine hesitation is in the middle. It does not mean that the vaccine will not be taken but that the vaccine is not going to be taken for today. How can we move the “hesitation” into “action” or vaccination?
There are a variety of reasons that Latinos have vaccine hesitation. The lack of trust of the federal government plays a major role in their decision. They fear having information about them will put a red flag and immigration may be notified. They are concerned about increased deportations.
They get their information from their peers and doubt the messages that have been sent out about COVID-19 that have not been consistent. They do not know who to trust, and do not have anyone they trust to go to. They need a PSA that is culturally congruent to the Latino community.
In addition, for the past four years, they have been intimidated through propaganda. They fear the stigma of being Latino, referred to as “rapists” and “drug dealers” in the last four years. They stay away from dealing with authorities, avoiding confrontations, and conflict. They are concerned about being visible, aware of the increase of hate crimes in our country.
Like the Tuskegee study, Latinos know about the abuse of minorities who have been treated unethically in research studies and believe it could be repeated with the new vaccination that has not been fully tested. With few Latinos participating in NIH research funding, they are unaware of the benefits of learning more about improving health outcomes through legitimate research engagement. They want to see Latino role models who take the injection before they do.
If they are hesitant about receiving it, what information can nurses give to them to help alleviate their fears?
We need to forge new community partnerships and work with people that are trusted by their peers. We need to communicate directly with people who are hesitant and educate them on this. For the Latino community, we also need to relay information in Spanish.
How can nurses who work in Hispanic communities working to build trust in the communities that they serve? How are you building that trust?
Though not specifically vaccine-related, the All of Us Research Program is working actively with partner organizations to build trust in communities and help educate people about the importance of research. The National Association of Hispanic Nurses is just one of those proud partners. We go wherever we can reach the community, as many times as it takes, and partner with other Latino organizations to build trust with the community. Compassion is essential, and we believe that one-on-one engagement will help close the gap on these inequities.
How can more research like the NIH All of Us Research Program help to prevent health disparities like this in the future?
The All of Us Research program allows Latinos not to be subjects in a research study but to be participants in the program. Through community-based partnerships, we are educating our Latino communities about research and the program. We want them to see that they can trust us and see that the community partners are in this with them. Through All of Us, we encourage all minorities to participate in our program because it impacts generations to come. Increasing self-awareness by Latino leaders in our organization will show that we lead by example and that we have faith in these programs. We must develop trust and protect Latinos from everything they fear (deportation, notification of immigration status, lack of safety in research studies). Consistent messaging of health prevention measures in Spanish must be available.
Patricia Cummings, BSN, RN, had an experience that most other nurses don’t get. She gave the COVID-19 vaccine to Vice President Kamala Harris and her husband, Second Gentleman Doug Emhoff. Cummings, a student in Walden University’s Master of Science in Nursing program and clinical nurse manager at United Medical Center says that it was a phenomenal experience, but also acknowledges how the Black community is facing challenges with people receiving the shot.
“My experience of being able to inoculate Vice President Kamala Harris and her husband was truly humbling and exciting. I feel honored that I was given an opportunity to be a part of history, as Vice President Harris is the first woman and the first African American and Asian American person to be appointed to that role. It is certainly one of the greatest highlights of my nursing career thus far,” says Cummings.
But she says that, initially, even she, a nurse, was hesitant about getting vaccinated. “I wanted to conduct my own research on the scientific background of the vaccine as well as speak with colleagues who are experts in the fields of infectious diseases and epidemiology. After reviewing the results of the clinical trials and the vaccine production process, I was convinced about the efficacy and safety of the vaccine, and hence decided to take it,” Cummings explains. “As the mother of two children, we have had to make several adjustments in our socialization, schooling, and other activities. I desire to return to a level of normalcy in my personal life, and I understand that getting vaccinated is presently the only viable solution to avoid contracting and spreading the virus. I am also saddened at the hundreds of thousands of lives lost as a result of the virus and am anxious to seeing the pandemic come to an end.”
Cummings says that one of the biggest challenges facing the Black community is having access to the virus. “Until recently, the vaccine was only accessible at a few hospitals and clinics that are typically far and inaccessible. Additionally, the registration process has been arduous and often requires one to be computer literate, as many sites require registration via the internet,” she says.
However, this isn’t the only reason why BIPOC are hesitant to get vaccinated. History has scared many people. “Hesitancy in the BIPOC population is primarily attributed to their distrust in the U.S. health care system. Historical events such as the Tuskegee Experiment, in which Black men were deceived regarding treatment for syphilis, have had lasting effects on the BIPOC community,” says Cummings. “Additionally, many have expressed skepticism about the short timeframe in which the vaccine was created and the fact that, at first, the only available vaccines required two doses.”
Cummings suggests that nurses can help alleviate patients’ fears because they’ve tended to be seen as people whom the BIPOC can trust as providing information. “Nurses should therefore provide factual information about the efficacy and safety of the vaccine based on their understanding of the clinical trials, as well as the vaccination process thus far,” she says. “Additionally, they should promote vaccination as a part of primary prevention, health, and wellness.”
Building trust in the community she serves is something that Cummings works on regularly. “As a student at Walden pursuing my MSN in the Nurse Executive program, I have learned the importance that the role of a leader as a change agent plays in influencing others to make beneficial choices. I have therefore chosen to put significant effort into sharing information about the vaccine’s efficacy and safety in hopes of building trust in my community,” says Cummings. “I also share my own vaccination experience and am transparent about my initial hesitancy. Additionally, I participate in community events that afford me a voice to safely share information and answer questions in real time.”
Another problem, though, faces certain minority communities—not speaking the same language. “One challenge that I believe exists among Hispanics and other non-English speaking populations is a language barrier. I have not seen adequate advertising and information provided in languages other than English. I believe that it is imperative that vaccine information is presented in a manner that is comprehensible to all people,” says Cummings. “It is important to add that I am passionate about health promotion and wellness. I believe that all people should be able to make informed decisions. My goal is not to strong-arm anyone into accepting the vaccine, but merely to provide them with truthful information and my own experiences in hopes that they make wise choices.”
Unfortunately, racism and gender inequality still exist not only in our country at large, but also in the nursing field. Because she saw this in anesthesia, Wallena Gould, EdD, CRNA, FAAN, founded and is the CEO of Diversity in Nurse Anesthesia Mentorship Program.
Gould took time to answer our questions. What follows is our interview, edited for clarity and length.
Fred Reed, DNP, CRNA, who has mentored many nurses of color interested in Nurse Anesthesia.
The homepage of the Diversity in Nurse Anesthesia Mentorship Program (DNAMP) states that only 11% of nurse anesthetists are people of color. Why is that? Why hasn’t there been more diversity in these positions?
Honestly, it stems back from decades of graduate nurse anesthesia programs accepting all white cohorts with only one or two nurses of color in each cohort. Also, contributing to the lack of diversity in the nurse anesthesia profession is the historical treatment of Black nurses at the turn of the century. In the early 1900s, until late 1940s, professional nursing associations did not include members of color just based on race. The American Association of Nurse Anesthetists (AANA), founded in 1931, included Black CRNAs into the membership in 1944.
In addition, nursing schools including nurse anesthesia programs were segregated until the late 1940s. One of the historical nurse anesthesia programs that consistently accepted diverse cohorts with faculty that mirrored the community since the Jim Crow Era was the Harlem School of Anesthesia founded by Goldie Brangman, CRNA, MEd, MBA. Founded in New York City in 1951, it lasted for 36 years. Brangman would later become the first and only Black Nurse Anesthetists who was elected as President of the AANA in 1973.
The emergence of diverse nurse anesthesia faculty started in the 1990s and has increased in small increments in the 124 graduate programs. In addition, contributing to the 11% of Nurse Anesthetists of color, is the lack of exposure or encouragement for nursing students of color to pursue Nurse Anesthesia at Historical Black Colleges & Universities, Hispanic Serving Institutions, and Tribunal American Indian Nursing Schools.
There is also gender inequality in nurse anesthetists. Does this mean that more nurse anesthetists are male than female? If so, why does this disparity exist? What has caused it?
According to the American Association of Nurse Anesthetists 2018 Profile Survey of Nurse Anesthetists, there were 52,000 CRNAs in the country with 59% of female and 41% male providers. Male nurse anesthetists were accepted into the membership in the 1950s, into what was a predominantly female profession. There was a stigma of male nurses in the profession from 1950s—2000s.
Today, more men are entering the profession, but still have a majority of female nursing school cohorts. Also, men are pursuing more specialized careers such as nurse anesthesia with the addition of military male nurses entering the profession.
Why did you establish DNAMP? What did you want to accomplish?
As a nurse anesthesia student enrolled in La Salle University in Philadelphia, I had an individual class assignment in the form of a poster project. My focus was to find out the racial and ethnic composition of the nurse anesthesia profession. In addition, I noticed that the six nurse anesthesia programs in the Philadelphia area did not have one full-time faculty teaching in the programs and only a few students of color in each program.
I was able to retrieve demographic statistics from the AANA and polled the Philadelphia nurse anesthesia students from each program. The data from the national statistics mirrored the Philadelphia programs, which demonstrated a severe lack of diversity in nurse anesthesia.
I approached one of our faculty members who taught regional anesthesia, the late Dr. Arthur Zwerling, DNP, CRNA, DAAPM, about my poster and my urge to do something about it. Dr. Zwerling encouraged me to attend the American Association of Nurse Anesthetists Annual Conference in Boston. As a senior nurse anesthesia student, I attended the conference as suggested.
On the first day of the conference, I met Goldie Brangman, CRNA, MEd, MBA (retired), spoke with her for a moment, and knew my purpose was going to make attempts to achieve diversity and equity in the profession.
Today, the non-profit organization, Diversity in Nurse Anesthesia Mentorship Program has mentored more than 510 nurses of color to successfully matriculate into 74 graduate nurse anesthesia programs. We are able to extend the pipeline to diversify the nurse anesthesia profession with a second initiative of a Diversity CRNA HBCU and Hispanic Serving Institution School of Nursing Tour. Lastly, we started our newest initiative with a Diversity Advanced Practice Doctorate Symposium with a collaborative effort of doctorate prepared CRNAs, Nurse Practitioners, Nurse Researchers, and Nurse Midwives to encourage nurses of color to pursue a doctorate and build a body of work.
How can the nursing community at large be an ally or offer support to BIPOC nurses who want to get into anesthesia?
Deans of Nursing serving at predominantly white institutions, HBCUs, Hispanic Serving Institutions, and Tribunal American Indian Nursing Schools can intentionally hire CRNAs of color as full-time, part-time or adjunct faculty. They can also invite CRNAs of color to classrooms to speak to nursing students about nurse anesthesia or teach didactic courses. This includes hiring CRNAs in doctorate-prepared nurse anesthesia programs and affording opportunity to be promoted in rank and publish in nursing peer-review journals. This need to be a national effort to make a profound impact in the trajectory of a diverse profession with accountability.
How does mentoring help assist and encourage more BIPOC to get into this facet of nursing?
For many nurses of color, myself included as a first-generation college graduate, we have been motivated, but just need proper direction in career trajectory. I was a registered nurse for eight years before enrolling in a graduate nurse anesthesia program. So, if CRNAs of color can mentor diverse nurses and nursing students prior to their enrollment into a graduate nurse anesthesia program, students will have the support needed to complete the graduate program successfully.
Is there anything else that nurses need to know regarding racism and gender inequality in anesthesia?
In many nurse anesthesia programs, nurse anesthesia students of color experience social isolation, microaggressions, and in some cases, racism as one of the few in their own program in clinical and or in the classrooms. Nurse Anesthesia students need to be very familiar with student policies and in certain cases, should direct any inequities to the Director of Diversity and Equity Officer for any concerns.
Bankert, M. (1989). Watchful care: A history of America’s nurse anesthetists. New York
Carnegie, M. E. (2000). The path we tread: Blacks in nursing worldwide, 1854-1994. 3rd (eds.). Sudbury, MA: Jones and Bartlett Publishers, and National League for Nursing.
American Association of Nurse Anesthetists (2018). AANA 2018 Member Profile Survey. Park Ridge: IL.
When Ortiz decided to pursue a PhD, she chose this topic to study. We interviewed her about it to see what all nurses could learn from her research.
How did you get interested in the traditional healing practices of Mexican-American Women? Why did you choose this for your PhD topic?
Growing up in deep South Texas on the coastal border with Mexico, I was raised in a bicultural/bilingual region where Mexican culture and traditions mixed with those considered American. My mom was a nurse, so when we were sick, she would take us to the pediatrician. However, if we were staying with our grandmother—my mom worked a lot—she would either administer home remedies or take us one block down the road to the local traditional healer.
As a child, I did not understand the difference between Western biomedicine and traditional medicine. I just knew that receiving care from my grandmother and the local healer felt so much more love-infused than when taken to the doctor. As I further explored complementary and alternative medicine and holistic nursing, the childhood memories of my grandmother’s healing rituals and remedies and the feelings of being deeply cared for returned.
My decision to study traditional healing practices among Mexican-American women of deep South Texas is more an act of honor and gratitude to my ancestral medicine-keepers than being strictly an intellectual endeavor. Through this work, I am returning home to learn from caregivers and healers with the intention of sharing what the traditional medicine from ancient Mesoamerica by way of Mexico can teach us today about well-being and healing in mind, body, spirit, and emotions.
Have you or anyone you know actually practiced these traditional healing techniques? If so, please say which ones and explain.
Plática – an organically unfolding heart-centered talk for arriving at the root of a problem and mutually working it through to resolution
Limpia – an energetic spiritual cleansing using various tools, such as healing herbs or a whole, uncooked egg, meant to harmonize imbalanced physical, emotional, mental, or spiritual aspects
Botanicals – the use of healing herbs and botanicals for numerous ailments (physical, emotional, or spiritual) in a variety of preparations, including infusions, tinctures, or in natural form; Commonly used are rue, basil, rosemary, chamomile, rose, sage, lavender, fever few, cinnamon, and aloe vera.
These practices are commonly noted in Mexican-American communities today, whether used by informal caregivers independently or with the assistance of a traditional healer.
How do you think that your research may help the nursing field? Should some of these practices be used in Western medicine? Or are you focusing more on how and why nurses should be aware of these practices?
My intentions are to share with nurses and health care practitioners and leaders what so many patients are practicing and have kept as valuable cultural expressions for improving health, healing, and well-being individually and collectively.
Why is it important for the health care field to be aware of these traditional healing practices?
The standard of high-quality health care includes being effective, safe, and culturally responsive. Knowing more about traditional medical practices in U.S. communities of Mexican origin and leveraging their potential for improving health expands opportunities for meeting those standards. Moreover, the U.S. medical system may come to learn additional approaches to health, healing, and well-being practiced by other cultures with positive outcomes. The World Health Organization’s Traditional Medicine Strategy has the incorporation of traditional medicine into Western health care systems as one of its goals for increasingly accessible and equitable health care worldwide.
Is there anything I haven’t asked you about that is important for our readers to know?
Curanderismo is the Spanish term describing traditional medicine from ancient Mesoamerica and currently practiced by many communities in Mexico, Central America, the Andes, and the Amazon. It comes from the word curar, meaning “heal.” In curanderismo, the health state means being in harmony internally and externally. Internal harmony balances the physical, mental, spiritual, and emotional aspects, while external harmony balances the self in relationship with others, the natural world, and the greater, multi-dimensional universe. However, this paradigm, in essence, acknowledges no separation between any of these elements.
Complementary and Alternative Therapies in Nursing
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