The United States Census Bureau reported in the 2000 census that 35.3 million Hispanics reside in the U.S. , about 13.0 percent of the total U.S. population. Approximately one in eight people in the United States is of Hispanic origin. According to the census, twenty-eight percent of people who speak Spanish do not speak English very well or not at all.

In Kansas , from 1990 to 2000, the Hispanic population rose from 7.0% to 12.5% of the population, making the Hispanic the largest ethnic group in the state. Over 30 percent of Spanish speaking people in Kansas do not speak English well or not at all.

Historically, minority populations throughout the United States have significantly poorer health outcomes compared to the majority population. Changes in the population and increases in the minority populations in Kansas create challenges in meeting the health care needs of the population.

A study in 2002 by the Kansas Health Institute funded by the Kansas Health Foundation and the Robert Wood Johnson Foundation, found that language barriers, poverty, lack of insurance and access to medical providers have caused health care disparities between minorities and white Kansas residents.

Non-English-speaking patients may be reluctant to enter the health care system, seeking care only when their conditions become acute and more costly. If they are not able to communicate effectively with patients, doctors may turn to batteries of expensive, often unnecessary tests. Language differences can cause treatment delays. It increases chances for errors and inability to follow directions for medications and treatments.

On August 11, 2000 , Executive Order 13166 was issued, “Improving Access to Services for Persons with Limited English Proficiency”, (HHS 2003), mandating guidelines on recipients for federal financial assistance to provide medical access to persons with limited English proficiency. This order emanates from Title VI of the Civil Rights Act of 1964. The executive order guidelines exist to ensure “that federally assisted programs aimed at the American public do not leave some behind simply because they face challenges communicating in English.”

The Institute of Minority Health , Education, and Research (IMHER) was founded in Wichita , Kans. on January 2003, with a mission that includes reducing health inequities among the minority community by influencing policies and providing interventions to promote health, prevent disease and ensure access to quality health care.

Our program, Survival Spanish for Health Care Workers, will provide a background in cultural awareness and knowledge in basic intercultural communication, in addition to training in basic Spanish language skills.

Madeleine Leininger, recognized as a pioneer in transcultural nursing, defines transcultural nursing as nursing care focused on differences and similarities among cultures, with respect to caring, health and illness, based on cultural values, beliefs and practices (Leininger, 2001).

Nurses and other health care workers such as mental health technicians, patient care assistants, physical therapists, and respiratory therapists provide hands-on care for their clients. Communication and understanding between the health care provider and the Spanish-speaking client is essential to the successful provision of culturally competent health care.

An important component of the program is cultural awareness and training in addition to the language skills in Spanish. IMHER recognizes that language skills are only a part of developing cultural competency. This course will provide background knowledge in developing cultural competency in health care.

Based on principles of adult learning (Reischmann, 2004), the program utilizes interactive lectures, simulations and role-plays, based on experiences of participants in the health care setting. The feedback and debriefing sessions will seek input from participants on how the exercises are meeting their learning needs.

Learning basic skills in any language requires more than a half-day course in the language. This program is developed as an introductory course to Spanish in the health care setting. IMHER will continue to work on an intermediate skills program to be offered in the future.

The first part of the program is a stand-alone program. It is a general informational session with introduction to basic vocabulary, with practice session, role-play, and feedback/debriefing. Non-nursing participants, such as chaplains, admissions personnel, and office personnel, may take this part.

The second part involves more nursing/health professional- based assessment and language skills. This would be more suited for nurses and therapists with hands-on practice with clients.

Survival Spanish for Health Care Workers fulfills the criteria for continuing nursing education in that it will enhance the practice of nursing for the registered nurse and the practical nurse, while building upon their education and experience.

Culturally and linguistically competent care is designed for the specific client, based on the uniqueness of the person's culture, and includes cultural norms and values. It includes self-empowerment for the client, and is provided with sensitivity for ethnic, racial and language differences.

Selected references:

http://factfinder.census.gov/

Kansas Department of Health and Environment Press release, May 1, 2000 , KDHE Receives Grant to Address Community Health Priorities.

Hegeman, R., (2002), Disparities in Health Care Plague Minorities in Kansas , Associated Press. http://www.hivdent.org/publicp/ppDHCPM012003.htm

Executive Order 13166 "Improving Access to Services for Persons with Limited English Proficiency”, 65 FR 50121 ( August 16, 2000 ).

Hegeman, R., (2002), Disparities in Health Care Plague Minorities in Kansas , Associated Press. http://www.hivdent.org/publicp/ppDHCPM012003.htm

Kansas Department of Health and Environment Press release, May 1, 2000 , KDHE Receives Grant to Address Community Health Priorities.

Leininger, M.M. (2001). Culture Care Diversity & Universality, A Theory of Nursing. National League of Nursing: USA .

Perkins, J. (1999). Overcoming Language Barriers to Health Care. Popular Government, Institute of Government , University of Carolina at Chapel Hill .

Reischmann, Jost (2004): Andragogy. History, Meaning, Context, Function. At: http://www.andragogy.net . Version Feb. 25, 2004 .

United States Department of Health and Human Services (2003) Revised “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons” (“Revised HHS LEP Guidance”) accessed at: http://www.lep.gov . Published Nov. 2003.

United States Census 2002. Website: http://factfinder.census.gov/

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