Nursing and Pharmacy Schools Cultivate Students’ Cultural Competency Skills Through Community Outreach

From the beginning of their educational careers at  Johns Hopkins School of Nursing (JHSON) in Maryland or the University of Cincinnati (UC) James L. Winkle College of Pharmacy in Ohio, students learn the importance of providing healthcare to underserved people through participation in community outreach opportunities. While students gain valuable cultural competency skills, they also play a significant role in reducing local health disparities by providing disadvantaged populations with low-cost, quality care. 

Patty Wilson

Johns Hopkins School of Nursing
The Center for Community Innovation and Scholarship (CCIAS), led by Patty Wilson, PhD, at JHSON, serves as one of two central hubs for the school’s many service-learning programs, connecting students to three East Baltimore locations where they work with patients: the Henderson-Hopkins School and Weinberg Early Childhood Center, the House of Ruth Maryland women’s shelter, and Wald Community Nursing Center. In addition to providing students valuable learning experiences, CCIAS strives to promote the well-being of underserved populations and to reduce health disparities.

The second center connecting students with a variety of service-learning opportunities is called JHU SOURCE. Founded and directed by Mindi Levin, SOURCE is the community engagement center for Johns Hopkins’ health professions schools and has partnerships with 100 nonprofit organizations. 

To serve patients at these facilities, enrollees in JHSON’s Master’s Entry into Nursing program are required to take the course “Community Outreach to Underserved Communities in Urban Baltimore.” The class covers topics such as the historical context of health in the city, the ways in which implicit bias can affect the quality of healthcare, and the importance of providing trauma-informed care to underrepresented groups. Those who complete the course become eligible to participate in the school’s Community Outreach Program (COP), which places them in community agencies. 

Mindi Levin

At either one of the three CCIAS locations or one of 20 sites affiliated with SOURCE, students commit to four hours each week on a volunteer basis or as part of a work-study arrangement. 

Through SOURCE, they have the opportunity to work with a wide range of residents. For example, students volunteer or work at the nonprofit organization Dayspring, which provides housing, education, and other services to homeless families in which a parent is in recovery from substance abuse. At Dayspring, COP participants teach women’s health classes or lead educational programming for children who live at the facility. 

At Gilchrist Hospice Care, students “visit with the patients and provide a comforting and supportive presence to families and loved ones,” says Levin. Another SOURCE site is Shepherd’s Clinic, an organization that offers healthcare to uninsured adults across multiple Baltimore zip codes. COP helps lead holistic healthcare services at the clinic’s Joy Wellness Center, where patients can take cooking classes, practice yoga and meditation, and receive diabetes counseling. 

Nursing students also get involved through COP at “Day at the Market,” an event in the Northeast Market in Baltimore. They join other vendors by setting up a table where they conduct blood pressure screenings, refer passersby to primary care providers, and provide basic health education regarding when patients should go to the doctor versus the hospital. 

Others provide tuberculosis screenings — commonly needed by people who plan to start a new job or enroll in school — and assist individuals who may not have a primary healthcare provider by compiling their medical information into a single document, which they call a “health passport.” This effort helps patients better track their healthcare needs and ultimately take more ownership of their health. 

Lisa Tran, now enrolled in the Doctor of Nursing Practice Family Nurse Practice HIV Primary Care program at JHSON, is a former COP student who worked at Wald Community Nursing Center, a CCIAS site. 

Wald, as the center is often referred to, exists to meet the needs of uninsured families and individuals by providing them with interim nursing services at no cost, connecting them with primary care providers, and helping them to move forward with their educational and employment goals. 

According to Tran, working at Wald greatly informed her perspective on the barriers that low-income patients face in obtaining quality healthcare. She recalls a patient who didn’t have home access to a phone or the internet and had to make a long trek to the local library simply to figure out how to navigate his way to the center. “Meeting this patient and others at Wald, I realized the journey to become fully culturally competent never ends,” Tran says. “What I need to do as a nurse and as a future nurse practitioner is to ask patients questions and not make assumptions.” 

Lisa Tran

Because the COP program encompasses such a variety of settings and services, participants can focus on specific areas within nursing that benefit patients from underserved and underrepresented groups. 

Jason Boyd, a second-year student in the JHSON Master’s Entry into Nursing program who worked for COP in 2017 and now serves as its student leader, says another benefit of COP is the opportunity to step outside the academic bubble. “It was nice to [interact with people] firsthand rather than sit in a classroom and talk about the social determinants of health,” he says. 

University of Cincinnati College of Pharmacy
The University of Cincinnati (UC) James L. Winkle College of Pharmacy provides volunteer opportunities for students to gain more detailed knowledge of underserved populations and effective ways of treating them through the St. Vincent de Paul (SVDP) Charitable Pharmacy and two homeless shelters in the area. Since pharmacists often serve as the first point of contact for many patients, such experiences help UC pharmacy students significantly increase their effectiveness with low-income patients and those who come from underrepresented groups. 

The SVDP Charitable Pharmacy, which has partnered with the UC College of Pharmacy for the past 10 years, provides a last resort safety net for those who have no other way to access their prescription medications; since 2006, it has filled 340,000 prescriptions worth $38 million. 

UC College of Pharmacy students build community with each other through their volunteer work at the charitable pharmacy and homeless shelters.

Students have different roles at the pharmacy depending on how advanced they are in their degree program. Those in their last year help manage patient therapy —  counseling individuals about their medications and assisting them with accessing resources. First-year pharmacy students focus primarily on filling prescriptions. On Saturday mornings, a separate group visits the pharmacy to measure patients’ blood glucose levels, educate them about their medications, and help them develop specific health goals. They also connect patients with primary care physicians if needed.

Ali Stith, the community academic partner coordinator and recruitment coordinator for UC College of Pharmacy, says working at the SVDP Charitable Pharmacy has taught her how to communicate with patients from a range of backgrounds and tailor her instructions to their varying literacy levels. 

Stith also runs monthly Saturday meetings with people who use the pharmacy’s services. These events allow patients to meet with pharmacy students and staff to discuss community developments that may affect them. For example, in one meeting, they discussed how the potential development of a new Major League Soccer stadium on the west side of Cincinnati could force low-income residents out of their neighborhoods, affecting their ability to access the SVDP Charitable Pharmacy. In this way, students are able to familiarize themselves with societal issues that could potentially affect patients’ health. 

Ali Stith

UC pharmacy students also work with underserved populations at two homeless shelters in Cincinnati: the David and Rebecca Barron Center for Men and the Esther Marie Hatton Center for Women. September through June, they operate clinics to address acute, urgent health issues, such as severe pain and infections. 

Student volunteers complete a variety of tasks, including making sure all the medications for the clinic are in stock, organized, and have not expired. They also ensure that newer volunteers follow rules and regulations around dispensing. 

Interacting with patients at the shelters provides valuable experience; for example, the opportunity to interview patients about their social histories, thereby increasing their understanding of the health issues faced by underserved members of the community. They also serve on an interprofessional team alongside medical students who create individual treatment plans for each patient. 

During the 2017-2018 academic year, 253 students volunteered; they treated 348 patients and dispensed 346 prescriptions. 

Tabitha Phillips

According to Tabatha Phillips, a third year PharmD candidate and the student community service coordinator at the two homeless shelters, serving patients at the clinic gives her the opportunity to interact with individuals to whom she wouldn’t otherwise have exposure. “The patient population is highly diverse, and [includes those] who are not typically going to other retail pharmacy settings,” she explains.

A typical interaction with each individual patient is 30 minutes, she says, which acquaints students with a variety of experiences and health needs. 

Building a Lifelong Commitment
For many students at JHSON and UC College of Pharmacy, the chance to provide much-needed care for disadvantaged community members shapes their long-term career aspirations and instills a lifelong passion for serving underrepresented groups. 

Tran, who is the daughter of two Chinese-Vietnamese refugees, planned to focus on global health when she began her nursing education. However, she says, working at Wald Community Nursing Center through JHSON’s COP program made her want to play a role in counteracting health disparities facing everyday Americans. “I realized,” she says, “that I wanted to put my resources and passion into my fellow citizens.”● 

Ginger O’Donnell is a staff writer for INSIGHT Into Diversity.  Johns Hopkins School of Nursing is a 2016 and 2018 Health Professions HEED Award recipient. University of Cincinnati College of Pharmacy is a 2018 Health Professions HEED Award recipient. This article was published in our January/February 2019 issue.