Sophia Navarro was nervous. It was one of the first times she had to speak Spanish with a patient as part of her nursing clinical last fall at the Community Health Care Clinic (CHCC) in Normal.
Dr. Susie Watkins, M.S. ’07, Ph.D. ’18., carefully observed the conversation.
“Sophia introduced herself in Spanish, and this male patient melted. You could see his comfort,” said Watkins, an assistant professor in the Mennonite College of Nursing (MCN). “It completely relaxed his demeanor, and Sophia was able to explain to him that she was getting his vital signs and blood pressure. And she didn’t know exactly how to say blood pressure. So she asked him (the term for that) in Spanish, he explained it, and they laughed.
“It was amazing because, from my lens as a non-Spanish speaking person, I can’t provide that level of comfort to patients. I’m so happy to have our students doing this.”
Navarro is among a group of nursing students who are working with patients at CHCC. The free clinic serves low-income McLean County residents, many of whom are Spanish-speaking immigrants who would otherwise fall through the cracks of the local health system due to a lack of money or health insurance.
The college is partnering with CHCC as part of a larger project, called Change Agents to the Underserved: Service Education (CAUSE), which also includes the McLean County Health Department and Chestnut Family Health Center. In 2018 Illinois State was one of 42 universities to receive a four-year $2.8 million CAUSE grant from the federal Health Resources and Service Administration.
The grant places 16 students a semester with these health care providers and will train 72 students over the course of the grant. The project also funds a registered nurse at each site who practices care coordination and transition management. These nurses also serve as preceptors for the students, providing them with training from an experienced professional.
CAUSE aims to empower nurses to work at the full extent of their education and training in primary care so they can help patients prevent and manage chronic diseases and ultimately keep them out of the hospital.
“We are changing our health care model from a treatment- based system to a proactive, preventive management-based system,” said Watkins, who serves as the CAUSE project director. “When we have nurses working closely one-on-one with patients to keep them on top of things and teaching them how to recognize their symptoms, then when they start to have an exacerbation, they can self-recognize that, contact the nurse immediately, and come into the primary care clinic before they get so sick that they have to go to the hospital.
“That’s the whole idea around more proactive disease management, and that’s what we really want our nurses to learn in this program. So when they graduate, they can join the workforce to help continue this work.”
Brigitte Lamar, B.S.N.’94, is the registered nurse care coordinator and preceptor at CHCC. She called the partnership between MCN and CHCC a “win-win” for the clinic and the University, especially considering 70 percent of the clinic’s patients are Spanish speaking. Navarro is one a few students who can speak Spanish well enough to converse with patients in that language.
“Our CHCC staff loved to have the students there because not all of their staff speak Spanish, and Sophia and the other students were able to do complete intake visits where they do the entire family history, social history, and health history assessment,” Watkins said. “And then they bring that back to the team and help the team prepare for their visit the next week. So it’s amazing from my point of view.”
Navarro and fellow B.S.N. senior Grace Taylor were among eight students who began serving patients at CHCC last school year. The Spanish-speaking component enables the students to put the patients at ease and communicate clearly with them, which is important considering the students are trying to persuade the patients to take certain steps to improve their health.
Navarro, whose father is from South America, grew up hearing Spanish at home and learned to speak it fluently in high school. Taylor minors in Spanish and further honed her language skills last summer while studying abroad in Chile.
“I love going to CHCC because I get to use my Spanish all day,” Taylor said.
Besides practicing Spanish, the students also are gaining a unique nursing experience through the CHCC clinical. It’s quite a bit different from the in-the-field training they normally receive at hospital-based clinicals.
Instead of treating patients who are dealing with acute health problems, CHCC’s staff help patients manage chronic diseases like diabetes and hypertension.
“I spend about five or six of my clinical days (a semester) at a hospital, and then the other three that I have left, I spend at the clinic at CHCC,” said Navarro, of Peoria. “So I have both the hospital environment where I can do Foleys (catheters) and IVs and all sorts of things, but then I also have three days, over three weeks, where I can spend at CCHC and practicing the skills that I have there. Working in a clinic is completely different from working at the hospital.”
At CHCC the students meet with patients and educate them about the health problems they are dealing with and how they can manage those issues. The students also learn about a whole range of medical issues, including alcohol and drug addiction, and how to interact with people from all walks of life.
For Taylor, these clinical experiences are giving her a chance to get a head start on her career. She plans to work at a clinic serving Spanish-speaking patients once she graduates.
Being able to speak Spanish with the patients is having an impact, Taylor said. It bridges the communication gap, so the patients feel more confident and in control of their health.
“It’s much less hands on than a hospital setting but much more education and verbally focused,” Taylor said. “So a lot of people with chronic diseases, they come in once a month or once every six months, and you check up on, ‘How are your different levels for things? What things are you doing to take care of yourself? How is taking your medication going?’ Then you work with that person to help improve the outcomes that they have with their treatment.”
It can be frustrating when the patients don’t follow the students’ instructions on how to manage their health.
“One of the hardest things is when you give a patient a plan, and they talk about it with you, and they’re really excited about it, and it seems like it’s going to work. They’re going to get better,” Taylor said. “And then they come back in a month, and it’s all down the drain. They haven’t done any of it, and they’re getting worse.”
As part of the CAUSE project, MCN is researching the outcomes of these nurse-patient interactions at each of the sites. The college is also working with an advisory board that includes representatives from Advocate BroMenn and OSF St. Joseph Medical Centers, which oversee CHCC, in order to ensure the students are getting the proper education to be ready to serve as registered nurses once they graduate.
The students have had to adapt during the coronavirus (COVID-19) pandemic by meeting with patients in virtual settings. In general, Watkins said more patients are being encouraged to enroll in a mobile health pilot program. Patients will use an app to enable the nursing students to communicate with patients daily about the health goals they set when they visited the clinic.
Opportunities like these and the clinical itself are giving the aspiring nurses a glimpse into the future, Taylor said.
“It’s a huge draw for a new student coming into ISU nursing, because it is such a great opportunity to get into this niche of nursing practice that hopefully is going to get bigger and bigger in the future. This program is ahead of its time, really.”