When it comes to pediatrics, health professionals face a number of challenges in providing quality care for minority patients. According to the American Academy of Pediatrics, severe racial and ethnic disparities exist in pediatric health and health care, and minority patients tend to experience greater difficulty across a wide range of categories, including infant health, access to providers, prevention, and chronic diseases.
Despite the challenges, minority nurses make a difference working with pediatric patients, says Charlotta Marshall , R.N., M.S.N., a hematology/oncology clinical nurse specialist at Children's Hospital of Michigan in Detroit. Nurses are proactively assembling teams of physicians, social workers, dieticians, family members, and other community advocates to provide excellent care, she says.
"You have all these health care disciplines around the patient, but as a nurse, you're in the middle. The nurse is often the coordinator, pulling people into the circle to meet the needs of the patient and family. Good health care means bringing together many professionals to work together for the benefit of the patient," she says.
Here's a look at the state of minority pediatric health, and how minority nurses are working to overcome the challenges they face while providing better care for their patients.
Nurses serve as a vital link between the patients they serve and the communities where their patients live, says Gwenda Grant, R.N., a New Brunswick, New Jersey–based pediatric clinical liaison with Bayada Nurses, a national home care company. "We help parents become better advocates for their children," she says. For example, Grant says many parents don't know the right questions to ask, or how to find extra resources, and nurses have to help bridge those gaps.
Frederica Williams is the President and CEO of Whittier Street Health Center in Roxbury, Massachusetts. She says nurses need to not only reach out to their neighbors but also become more visible, especially in minority communities. "We have to get out there in the schools and churches to educate families about good health care."
Whittier staffers implement education programs in the neighborhood, faith-based institutions, and even prisons to educate people about health topics. According to the center's website, these efforts have reached 20,000 local residents in addition to their regular patients.
Professionals also go into the schools to talk about prevalent issues, including obesity, human papillomavirus (HPV), and mental health issues, Williams says. "We can't just be a building in the community. Our focus has to be expanding our public health outreach in the community," she says.
Though community efforts are helpful, minority pediatric nurses say cultural and linguistic barriers still exist in health care. "Many patients in minority communities come from different backgrounds and speak different languages," says Williams.
According to Williams, these language barriers can lead to a lack of understanding and treatment problems, or even a misdiagnosis. For that reason, she says it's important for health care professionals to be able to speak multiple languages and be familiar with the cultural backgrounds of the families they serve. If more minorities go into nursing, Williams says there is a greater likelihood that they'll be able to linguistically and culturally connect with a more diverse set of patients.
With health care costs rising steadily, minority nurses are instrumental in helping patients find financial resources to pay for their children's services, says Maria Arteaga, R.N., Director of Nursing at LaSalle Medical Associates in San Bernardino, California.
According to Arteaga, most of the families of pediatric patients in her community are concerned about how they're going to be able to pay for health services. A majority of her patients have low incomes, so when their children are admitted, she says their first question is often, "What is this all going to cost?"
Nurses can respond by helping parents learn about governmental program that are offered to low-income families, says Arteaga. "We work hard to understand what's available to them."
Many patients also fear that their children's treatment will be insufficient, because they don't have the money to pay for expensive "high-quality" care, says Arteaga. LaSalle nurses help patients understand that they will be receiving quality medical care, no matter what their socioeconomic status is, she says. "We explain to the patient that, regardless, we treat them with respect and they can be confident with our services."
Williams says that whether or not patients embrace that message is a matter of trust, and minority nurses are a crucial part of helping build such trust among minority communities.
Whittier provides cultural competency training for its entire staff, so that the center can better serve its community. "We're serving populations that have had to deal with racism and classism," says Williams. "Many times, patients have told us that [being at Whittier] is the first time they have been dealt with dignity and respect." Williams says this is one of the best compliments she can receive.
Though minority nurses are making strides in serving their communities, many report that their minority pediatric patients face a disproportionate number of health problems when compared with other pediatric populations. It takes a dedicated staff to help patients eliminate or reduce these challenges, which range from childhood obesity to teen dating violence.
According to research published by the U.S. Department of Health and Human Services (HHS), African American children in 2007–2008 were 30% as likely to be overweight than non-Hispanic white children. Mexican American children were 1.4 times more likely to be overweight as non-Hispanic white children, according to a 2009 survey.
"In the African American community, there is a higher rate of obesity in pediatric patients," says Dana G. Rader, R.N., M.S.N., C.N.M., a nurse practice leader with Women and Children's Services for Kaiser Permanente's Mid-Atlantic region. In fact, she says childhood obesity has been targeted as a "hot topic" for the nurses in her facility.
"We're working together to expand the nurse's role in following and educating patients regarding their BMI and nutrition," Rader says. She and her colleagues are creating a resource packet for nurses who need to talk to parents of patients about BMI, pediatric standards, and teaching children how to exercise and eat better.
As a minority nurse, Rader advocates taking a proactive role in reaching these patients, which can help prevent future health problems when pediatric patients become adults. "A lot of our preventative diseases stem from poor nutrition," says Rader. "We need to talk about managing and preventing these conditions and not waiting until that obese child becomes an obese adult with Type 2 diabetes."
For some communities with high levels of crime, fighting obesity involves more than educating parents about exercise, says Williams; it means finding them a safe place to exercise. For instance, many parents and guardians that come to Whittier may feel that it's safer to keep their children indoors, she says. And if kids stay inside, they could gain weight at a faster rate.
With these concerns in mind, Whittier nurses help battle obesity with a free afterschool program called Race Around Roxbury (named for the neighborhood where the health center is located). It's a year-round program that helps overweight and at-risk adolescents learn about healthy eating, exercise, and high self-esteem, says Williams.
Children work in groups and complete fun activities that help them reach nutrition and weight goals. As part of the program, nurses teach children how to make healthy dietary choices, but they also work with parents to show that everyone can eat healthy on a budget. Race around Roxbury also collaborates with a local gym that sponsors child-focused activities, such as karate. All of the children in the program also attend a healthy weight clinic at Whittier where nutritionists, case managers, and physicians work with the children to determine nutrition and weight loss or stabilization plans.
During the program, children can earn prizes such as MP3 players or inexpensive sports equipment as awards for participation. "We're giving children incentives, but we're also teaching them lifelong habits about nutritional habits and exercise," Williams says. She adds that the program has been successful and 100% of the children enrolled have made some type of lifestyle improvement.
Teen dating violence
According to Rader at Kaiser's Women and Children's Services, another important challenge for nurses is helping eliminate dating abuse. She says some studies have shown that as many as one in four teens report being physically, verbally, or emotionally abused every year.
Recognizing symptoms of abuse is especially important for minority pediatric patients, Rader says. "As we deal with minority communities, it's something that's not talked about a lot. Sometimes we have a culture that says [abuse] is what you should accept, but this is not acceptable."
According to Rader, many teens don't recognize the signs of an abusive relationship, such as verbal threats and insults or physical violence. Or if they do recognize the signs, they grow to accept it. "In pediatrics, [abuse symptoms] are not an obvious risk factor for professionals. But we should be sharing more patient material with teens," she says.
Rader suggests nurses talk to teens more frequently about potential abuse symptoms and make sure their patients know about community resources should they find themselves in an abusive relationship. "We need to reach out to teens because this problem is becoming more prevalent," she says.
According to the Office of Minority Health, African American babies are four times as likely to die due to low birth weight complications and premature birth than non-Hispanic whites. In 2008, 12.3% of all U.S. births were premature, compared to 17.5% of African American births alone. The Office of Minority Health also reported in 2006that African Americans had an infant mortality rate 2.4 times higher than that of non-Hispanic whites.
Minority nurses can address this issue by helping pregnant women learn where to go for prenatal education and resources, Rader says. Nurses can also encourage moms to breastfeed "not just after birth, but also six months to a year later," she says.
Some health care centers are advocating a group approach to prenatal care. Whittier has implemented an obstetrics program that focuses on grouping doctors, nurses, and midwives together with pregnant moms. A group of about 8–12 pregnant mothers, who are close to each other in gestational age, work with medical professionals to learn about proper prenatal care as a part of Whittier's Prenatal Care clinic and the OB/GYN department.
"The results have been shown to help reduce low birth weight and premature birth," Rader says. The education offered in such a supportive group setting has helped mothers give birth to healthier babies in Boston where, according to statistics published on Whittier's website, black mothers have the highest infant mortality rate, and 75.8% of black pregnant women receive adequate prenatal care, compared to 86.7% of white pregnant women.
Melissa Strachan, R.N., a pediatric nurse at Whittier, says another issue minority pediatric patients face in large numbers is the management of chronic illnesses, such as asthma. She says many of her patients live in public housing, which includes old buildings that can aggravate asthma symptoms.
Asthma can interrupt classroom time and parent work schedules when the symptoms become severe. "Kids are missing school because of preventable asthma attacks," Strachan says.
Health care facilities can address these challenges by going to the community and educating parents about prevention and treatment, Strachan says. "Whittier hosts an asthma focus twice a month with providers, a case manager, and an on-site pharmacy," she says. Whittier also hosts an asthma clinic every Wednesday afternoon where pediatricians and pharmacists review medication management and asthma education.
Strachan says the clinic exists so patients receive prompt care and treatment. "We look at what's happening with their home environment so we can help prevent them from being sick and missing school," she says.
According to Arteaga, some parents skip vaccinations because they have a hard time adjusting to the idea of paying for care when their child is not sick. The cost of good medical care is always a concern, but in many cases, these parents don't know about the programs that help cover the cost of child immunizations, she says. To help boost immunization rates in these situations, Arteaga says minority pediatric nurses can make sure parents are aware of any community programs that help pay for preventative medical care.
At LaSalle, Arteaga says she proactively reaches out to families in her community to make sure patients know what's available. "I keep a record of every single child that's being immunized. We call them [when it's time for their next vaccination], send letters and send cards, and we do the best of whatever is possible, whatever it takes," she says.
As nurses help their minority patients face a wide range of health challenges, they find the pediatric specialty a fulfilling way to give back to their communities. "I've always had a love of children and in caring for their welfare," Rader says. In fact, she says it was a positive experience with a nurse practitioner when she was young that made her decide to go into the pediatric specialty. Rader recalls that the nurse took what could have been a scary health procedure and helped her feel at ease. She now hopes to provide similar experiences for her patients. "I want to give children as healthy a start as possible," she says.
Rader says working in pediatric nursing helps her make a positive change in children's lives, and by doing so she helps bring about a positive change in their families and their neighborhoods as well. "It's rewarding to be able to change not only one person, but to change an entire community."
Other minority pediatric nurses agree. "There are people who enter the nursing field because of financial reasons only, and not because of what's in their heart," says Marshall at Children's Hospital of Michigan. "But I always tell students to make sure they want to be a nurse." She considers her career to be more than a job. "You want pediatric nursing to be a calling."
"Our center serves all ages, but I believe our kids are the future of our area," Arteaga says. "Children are the door of the family. If the parents don't have the education, the kids can provide information." And nurses can share vital health care information with families via children, she says.
Gwenda Grant adds that pediatric nursing allows nurses to see great success in some of the smallest things, such as taking a patient off ventilator support. "We see children start to eat, and we see their progress," she says. "You can see the joy and delight in the eyes of parents when a child reaches a simple milestone, such as being able to pick up a toy."
Though pediatric nursing can be gratifying, some nurses may avoid the specialty because it can be emotionally draining to care for very sick children on a regular basis. "I used to feel that way," says Rader, "but then I realized that it takes a special person to push through their own pain and discomfort in seeing children in pain, and knowing that the nurse's work is for the greater good." Minority nurses who stay in pediatrics can experience the benefits of helping kids get healthy, Rader says. "You get way more in return for your willingness to work with children and teens."
Marshall, who works in hematology and oncology, agrees that it can be difficult dealing with children who face life-threatening health obstacles. "Some people have a fear of working with children who are sick and have a potential for dying," she says. "But instead of crawling under a rock, I think about what I need to do to help, and do it."
For Marshall, this means forming interest groups with other nurses who treat patients with similar diseases so they can advance best practices. She also participates in medical fundraising efforts. "It's important to be able to reach out to help others in any way you can," she says.
Even though nurses primarily assist the medical needs of their patients, they also provide a secondary benefit—they show children that nursing is a good career choice, says Williams. Minority nurses can help minority children and teens picture themselves working in the medical field, she says. "A lot of our kids don't have that example at home, so our patients look up to us as examples."
Doctors and nurses should go to schools in their communities and let kids know that if working in health and medicine is what they aspire to do, they can do it, Williams says. Whittier health professionals often serve as mentors, and some high school students gain hands-on experience at Whittier through internships. "We want to teach kids about all the different opportunities in health care," Williams says.
Minority pediatric nurses should also look for ways to further their own education whenever possible, Marshall says. This could include earning new credentials, joining affinity groups, and mentoring other nurses. "Show, demonstrate, and build your clinical skills to deliver excellent patient care," she says.
Minority pediatric nurses may face a number of challenges in their communities, but they also have ample opportunities to create positive change, Williams says. It can be especially fulfilling to meet the needs of the youngest patients. "My message is, don't be afraid of the pediatric nursing environment," she says. "There are a lot of loving people."
This article is the first in a two-part series concerning minority pediatric health. Part two, devoted specifically to the infant mortality epidemic, will appear in the fall 2011 edition of Minority Nurse.