- Use the interview questions developed in Module 2 based on Module 1’s mind map and the textbook’s FIG. 1.1 and FIG. 1.2 in Chapter 1 as the blueprint and guide for your interview.
- Take notes during the interview to capture the key points discussed.
- Use voiceover PowerPoint, Canvas Studio Screen Capture, Teams, or Zoom to narrate the PowerPoint presentation you will create to share the results of the interview.
- Be sure to answer the following questions in the presentation:
- Did your preconceptions or stereotypes influence the interview process?
- What cultural factors emerged during the interview that could impact healthcare decisions?
- How might you adapt your nursing practice to provide culturally competent care for individuals from this cultural group based on the interview insights?
- The presentation is to be original work and logically organized, formatted, and cited in the current APA style, including citations and references.
- The PowerPoint presentation should consist of 10-15 slides and be 10-15 minutes in length. Use voiceover PowerPoint, Canvas Studio Screen Capture, Teams, or Zoom to narrate the PowerPoint presentation.
- Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Q: Do you associate yourself with a specific culture/ religion? – A: Yes, I identify strongly with Haitian culture and I practice Christianity, which plays a
significant role in my life and decisions.
Q: What language are you most comfortable speaking in a healthcare setting? – A: I am most comfortable speaking Haitian Creole. While I can speak some English and
French, Creole is my preferred language for discussing important matters like health.
Q: Are there any cultural norms regarding privacy and modesty that we should be aware of during your care?
– A: Yes, privacy and modesty are very important. I would prefer female healthcare providers for intimate examinations and expect privacy during such procedures. It is also important to cover as much of my body as possible during examinations.
Q: Who are the key decision-makers in your family or community when it comes to healthcare? – A: In my family, healthcare decisions are usually made collectively. My husband, parents,
and sometimes even extended family members like aunts and uncles are involved in making important health decisions.
Q: How involved do you prefer your family or community to be in your healthcare decisions? – A: I prefer my family to be quite involved in my healthcare decisions. Their support and
input are very important to me, and I often rely on them for advice and emotional support.
Q: How do you prioritize long-term vs. short-term health goals? – A: I try to balance both, but I tend to focus more on short-term health goals because
immediate health concerns can often feel more pressing. However, I understand the importance of long-term health goals and try to follow medical advice for preventative care as well.
Q: Do you use any traditional or alternative remedies alongside conventional medicine? – A: Yes, I often use traditional remedies alongside conventional medicine. For example, I
might use herbal teas and natural oils for minor ailments. These remedies are part of my cultural heritage and I believe they are beneficial.
Q: How do you feel about the use of technology and modern medical interventions in your healthcare?
– A: I am open to using technology and modern medical interventions, especially when they are explained to me thoroughly. However, I also value traditional methods and like to incorporate them when possible.
Q: Are there any genetic or hereditary conditions that are common in your family or community? – A: In my community, high blood pressure and diabetes are quite common. These
conditions run in my family, so we try to manage them through both medical treatment and lifestyle changes.
Q: Can you share any previous experiences with healthcare providers that were particularly positive or negative?
– A: One positive experience was when a nurse took the time to explain my treatment plan in Creole and ensured I understood everything before proceeding. A negative experience was when a doctor dismissed my use of traditional remedies without considering their importance to me culturally. This made me feel disrespected and hesitant to share my full health practices in the future.
,
1This entails the sharing of information through speech, tone of voice, body language, and the use of silence. A patient from a
culture where making direct eye contact with a healthcare provider is considered impolite may choose to avoid doing so
in a medical setting. Recognizing this can help avoid misinterpreting the patient's actions.
COMMUNICATION
2
3This includes social structures that shape an individual's values and behaviors, such as family structures, religious organizations, and others.in
contrast to cultures that place a strong emphasis on individual decision-making, a patient from an Asian
culture may involve extended family members in healthcare decisions.
SOCIAL ORGANIZATION
4 This concerns how time is seen in different cultures, particularly the value of timeliness and orientation
toward the past, present, or future. On the other hand, some cultures—like those found in many regions of Africa or Latin America—might have a more laid-back attitude
toward time, making it more acceptable to be late.
TIME
SPACE 5 This includes the use of traditional treatments, illness
prevention, and health practices based on the concept that one can control nature. For example, a patient with
Native American ancestry may choose to use herbal remedies and traditional healing methods in addition to
or instead of conventional medical care.
ENVIRONMENTAL CONTROL
6 This is a reference to the physiological and genetic variations that affect health between racial and
ethnic groupings.For instance, African Americans are more likely to have sickle cell anemia, but
Caucasians of European heritage are more likely to have cystic fibrosis.
BIOLOGICAL VARIATIONS
THE SIX CULTURAL
PHENOMENA
This relates to people's comfort levels with physical touch and the physical space they keep between them during interactions. In contrast to American inclinations for more personal space, several Latin
American cultures, for instance, value close personal space and touch during conversations.
For this Discussion, you will utilize the expertise of your colleagues to assist you in developing your Personal Legislative Agenda. You will construct 1-2 questions regarding any areas of concerns or guidance for colleague support and suggestion.
TO PREPARE:
- Begin work on the Personal Legislative Agenda (attached below-example provided).
- Consider questions or concerns you have about your plan.
Post a response detailing the following:
Construct one to two (1–2) questions for your colleagues detailing any questions or concerns (in paragraph form) you may have regarding the Personal Legislative Agenda. Your questions should clearly describe areas you may need clarification and/or guidance for the continuation of your work on the Personal Legislative Agenda.
1
Personal Legislative Agenda & Action Plan
(Student’s Name)
Context: I am a Family Nurse Practitioner and volunteer two afternoons a week at a free primary healthcare clinic in South Florida. The majority of our families are Latino or Haitian immigrants, and most of the children have at least one undocumented immigrant parent. None of the families have health insurance, many suffer chronic conditions (such as, asthma, diabetes, and HTN), and their only source for medication is from the clinic.
Problem: The fear of deportation, incarceration, and/or family separation discourages undocumented immigrant families from seeking healthcare until the symptoms are so severe, they can no longer be ignored. There are very few specialists who will accept our referrals; those who do have long wait times for appointments or are too far away for most of our families. Access to affordable health insurance and comprehensive healthcare services are desperately needed for undocumented immigrant families in South Florida and across America.
Proposed State Legislation: HB 135/SB 640: Florida Kidcare Program Eligibility
My position: Support Oppose Amend Watch
Proposed Federal Legislation: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021
My position: Support Oppose Amend Watch
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Proposed Legislation
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Summary/
Description
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Process &
Update
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My Advocacy Actions
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Current
Status
of Proposed Legislation
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Next Steps
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State: HB 135/SB 640: Florida Kidcare Program Eligibility
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Increases income eligibility threshold for coverage under Florida Kidcare program; excludes undocumented immigrant children from eligibility
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9/20/21: HB Filed
10/26/21: SB Filed
9/29/21: HB
referred to Finance & Facilities Subcommittee; Healthcare Appropriations Subcommittee; and Health & Human Services Committee.
11/16/21: S 640 referred to Health Policy; Appropriations Subcommittee on Health; and Human Services; Appropriations.
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Sent email thanking Representative Bartleman and Senator Hooper for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the Florida Association of Nurse Practitioners (FANP).
After reviewing the bill co-sponsors, I saw that my elected officials were not listed. Sent an email to my district legislators, Representative Joseph and Senator Pizzo to encourage them to co-sponsor the bill.
Signed up with Florida Senate Tracker to receive legislative updates on the status of the House and Senate bills.
Wrote a 250-word editorial for the Miami Herald praising the bill and pointing out the need to include undocumented children. It was published on 11/10/21.
I talked with co-workers at the clinic about the legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.
I’m a member of the county’s Women’s Democratic Club and talked about the legislation at our monthly meeting.
Neither of my elected legislators sit on any of these committees. I worked with FANP and Catholic Charities Immigration & Refugee Services to develop testimony about my experiences with undocumented immigrant families and children in South Florida; and worked collaboratively to develop a fact sheet comparing the health of immigrant and nonimmigrant children in Florida. Both were presented by organization lobbyists at the Health Policy Committee hearing for the Senate bill, with a request to amend the legislation to include undocumented immigrant children.
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1/5/22: HB 135 was withdrawn.
3/14/22: SB 640 died in Health Policy.
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Send thank you emails (as a member of FANP) to all sponsors and co-sponsors of the House and Senate bill.
I am on the Legislative Action Committee for FANP. Plan to attend meeting at the end of the session with our lobbyist to determine why the bill failed in two committees.
Work with FANP, Catholic Charities, and the bill’s legislative sponsors to research opposition to the bill and determine future plans to reintroduce a revised version.
Suggest to FANP that, moving forward, we consider forming a coalition with other nursing organizations, safety-net providers, and immigrant advocacy organizations. This would give us more resources, broader support across the state, and a more developed grassroots presence.
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Federal: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021
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Eliminates the 5-year wait for immigrants to enroll in Medicaid and Children's Health Insurance Program coverage; excludes undocumented children and families from eligibility
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5/12/21: HR filed 5/13/21: HR referred to Subcommittee on Health
5/17/21: S filed and referred to Committee on Finance.
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Sent email thanking Representative Jayapal and Senator Booker for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the ANA and the American Association of Nurse Practitioners (AANP).
After reviewing the 90 co-sponsors in the House and 11 co-sponsors in the Senate, I saw that my elected officials were not listed. I used GovTrack.us to send an email to my congressmen, Representative Salazar and Senator Rubio encouraging them to co-sponsor the bill; there are no Republican co-sponsors in the House or the Senate.
Signed up with the Congress.gov tracking service to receive legislative updates on the status of the House and Senate bills.
Posted my support of the legislation, a link to a fact sheet on HEAL, and a “Contact your Legislator” link on my Facebook page. I also tweeted my support of the legislation to my Twitter account.
I talked with co-workers at the clinic about the federal legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.
I’m a member of the county’s Women’s Democratic Club and talked about the federal legislation at our monthly meeting. They were able to refer me to other local and regional groups that may be interested in learning more about and supporting the bill.
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Pending: Still in the Subcommittee on Health and Ways and Means Committee in the House and the Committee on Finance in the Senate.
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The ANA and AANP have not published positions on this legislation; legislation is not listed as a specific priority on the website.
I researched 19 advocacy groups supporting the legislation. I decided to join and financially donate to two—First Focus: Campaign for Children, and National Partnership for New Americans.
Both have legislative alert services and a national grassroots activism initiative.
Since neither of my congressmen serve on the committees that will be hearing the bill, working through an advocacy coalition complements my individual activism.
I will contact them to see how I can best support their efforts to advance this bill.
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Connecting Kingdon’s Theory of Policy Change to My Personal Legislative Agenda & Action Plan
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Kingdon’s Three Streams
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Relevance to My Personal Legislative Agenda & Action Plan
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Problem
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The problem is that many immigrants do not have access to health insurance in South Florida and other parts of the country. The problem is further complicated by the fact that all immigrants are not seen as equally important or of value. They are separated into two groups—those who are here lawfully and those who are undocumented. It is important to my Personal Legislative Agenda & Action Plan that the problem definition be inclusive of all immigrants so that the most vulnerable among them—the undocumented—are included in the proposed policy solutions. Unfortunately, inclusivity creates divisiveness in how the problem is defined.
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Politics
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Nationally, there is no consensus across party lines regarding the provision of healthcare services or health insurance to undocumented immigrants. In Florida, the legislative and executive branches of government are controlled by the party that is unsupportive of undocumented immigrants. Also, healthcare is not seen as a basic human right in the U.S. Non-citizens cannot vote and therefore have no voice in the legislative processes. As a citizen and as a nurse, I have a moral and ethical responsibility to advocate for vulnerable populations who are denied the opportunity to speak for themselves.
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Policy
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While there have been some initiatives to expand Medicaid or offer the opportunity to purchase health insurance for immigrants who are here lawfully, undocumented immigrants are excluded from these proposals. While I support all policies that address the unmet needs of immigrants, I also must ask that policies excluding the undocumented be amended to include them. Policies that separate families, defund sanctuary cities, or unduly limit immigration exacerbate the problem and contribute to ongoing poor health outcomes and health disparities among immigrants. Part of my Personal Legislative Agenda & Action Plan is to monitor health policies that negatively impact (or exclude) this population as well as be aware of—and challenge—other immigration policies and regulations that indirectly contribute to the problem.
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Likelihood of Policy Change
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It is unlikely that the state and federal immigration and health reforms, I support, will be approved any time soon. There are deeply ingrained challenges in both the politics and policy streams at both levels of government, and the “legal” vs. “Illegal” differentiation prevents a single definition of the problem. My Personal Legislative Agenda & Action Plan, however, reflects my long-term commitment to raising awareness on this issue and advancing these policy priorities.
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Next Steps
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It is important for me to remain aware of issues and public/political opinion that frame the issue of immigration reform. To that end, my Personal Legislative Agenda & Action Plan includes subscriptions to legislative alert services at the state and federal levels. I also belong to two organizations that advocate for immigrants at the state and federal levels, which send alerts when state or federal proposals or regulations are introduced that impact the immigrant population. I already participated in one online campaign on this issue.
I am learning to carefully read and analyze proposed legislation, so I can engage with my elected officials in an informed manner.
As a Catholic, I have also financially contributed to and become a grassroots member of Catholic Charities-Immigration and Refugee Services, which has allowed me the opportunity to raise awareness and discuss my experiences with immigrants to congregations in my area.
I was recently asked to prepare committee hearing testimony that could be adapted and submitted at some future point, when needed.
I am also a member of the Florida Association of Nurse Practitioners, and I serve on the organization’s Legislative Action Committee. In that role, I have been able to raise awareness of immigrant health issues in the organization and in our “Policy Watch” endeavors at the national level. I am a member of the American Association of Nurse Practitioners and the American Nurses Association (ANA). (The ANA has an Issue Brief
supporting healthcare for undocumented immigrants.)
Although I am not a “single issue” voter, I am mindful of candidate positions on immigration reform and plan to contribute financially to—and vote for—those who most align with my values and priorities as a nurse and citizen.
I need to learn more about the opposition to these reforms, so I am better prepared to address their arguments. I plan to listen to media sources more aligned with the opposition and to search the literature to separate fact from hype and opinion. I have learned that the key to policy advocacy is to be informed and prepared, so when engagement with my elected officials is needed (on an issue I am passionate about), I’m ready to engage.
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