This Boise State professor has a nurse-driven plan to build cultural bridges, bonding caregivers and seriously ill refugees
Dr. Katherine Doyon has a plan … and $100,000 thanks to a grant from The Rita and Alex Hillman Foundation.
The rare two-year grant will help mold the building blocks for what should be a first-of-its-kind bridge between Idaho healthcare providers and refugees.
“Because we need to understand as a health care team how to talk to people regardless of where they are from - whether you are a rural farmer or you are a city dweller or you are Muslim or you are Christian, it shouldn't matter,” said Doyon. “Your clinician walks in the room and needs to create a conversation with you and a trusting conversation.”
Over the next two years, Doyon and a Community Advisory Board – compiled of healthcare providers, refugees and refugee advocates – will design a guide to bridge clinicians and refugees, communicatively and culturally.
Doyon visited with Morning Edition host George Prentice to share her enthusiasm for the soon-to-launch project and how it could, quite literally, save lives.
“We need our refugees to feel comfortable and confident, confident navigating our system in order for that to have better outcomes.”
Read the full transcript below:
GEORGE PRENTICE: It is Morning Edition on Boise State Public Radio News. Good morning. I'm George Prentice. Well, in the last few years we have learned so much about our systems of care and in particular we think we've identified a number of challenges… certainly some gaps… especially among those populations who may not have regular access to care. Dr. Katherine Doyon is here. She's an assistant professor at the School of Nursing at Boise State University. Dr. Doyin, good morning.
DR KATHERINE DOYON: Good morning. Thank you for having me.
PRENTICE: What caught my attention is this grant that was recently announced. You are the recipient. I understand the grant is from the Rita and Alex Hillman Foundation. But break it down for me and our listeners. How might you explain to a layperson what you're about to do?
DOYON: I’ve been working on this grant for quite a while, and what in a nutshell, I am creating a communication intervention or communication guide to facilitate communication between the health care team and refugees. The guide really is I'm envisioning a short, maybe five or six suggestions from our community about how to facilitate that initial communication between provider and patient. So, one arm, I have a community advisory board that are the providers, nurses, health care workers, physicians and the other arm are refugees themselves. And together we are going to create this short guide that will hopefully improve communication between refugees with serious illness and the health care team.
PRENTICE: I've got 100 questions already. But let me let me start with this. So, where what's the back story of this? Where how did this come onto your radar?
DOYON: As a PhD student at the University of Utah, my dissertation was on really looking at how people at end of life communicate with their providers. So, I had that foundation and then I did a postdoc at the University of Colorado where I explored. I did something very similar with patients who identify as black or African American and the Denver community. And knowing I was pivoting, all of my research was going to go to Boise State and also my background as a public-school teacher, knowing that you can't really create there's not one magic bullet. You can't say, do these five things and you're magically going to be able to communicate with everybody and everything is going to be harmonious. I was a teacher in New York City, wherever it was.
PRENTICE: So, at what level?
DOYON: Yes, I was a public-school teacher in Lower Manhattan for eight years in a again, a public school high school. So, I taught because of my background as a nurse, I taught anatomy and physiology. So, it was a very humbling experience. Working with teenagers is very humbling. But we had students from all over the world and we had students who were proud of where they were from. We had students who were embarrassed from where they were from, and you never really knew until you talk to them. And so now I bring that fast forward to my research and it's it's the same. You never really know what's important to a person, what aspects of their culture, of their home, of their religion are important to them. And so this research is going to help facilitate communication so that clinicians can help patients share what's important to them, what their value system is, and how to navigate the health care system. And in my opinion, refugees need this intervention because they don't know how to navigate our health care system. I mean, I'm a nurse, I've been a nurse for over 20 years. I still don't know how to navigate our health care system and people with serious illness. And that's specifically what an Alex Hillman Foundation targets is palliative and hospice care. Oh, they it's an emergent need. So, you can't have that learning curve where you are learning how to navigate the health care system. It really impacts health outcomes. And the refugee population in particular was a population that I wanted to work with because we need to understand as a health care team how to talk to people regardless of where they are from, whether you are a rural farmer or you are a city dweller or you are Muslim or you are Christian, it shouldn't matter. Your clinician walks in the room and needs to create a conversation with you and a trusting conversation. One of the reasons I gravitated to the Rita and Alex Hillman Foundation is because it celebrates nurses. And, you know, again, it might be a. A little bit biased because I am a nurse. We do enjoy a relationship with patients that we have, a trusting relationship with patients. We are nurses are consistently you're after you're rated number one as the most trusted profession. Working with refugees with serious illness is it's an emergent need. Clinicians, whether they be nurses, nursing assistants, physicians. The literature is full of the health care team requesting more information, how to be better at starting communication, because we don't know exactly. We you can't say someone from South America needs you to talk to them this way. Someone from sub-Saharan Africa needs you to talk to them this way. We can't do that right. It's to everyone has their personal preferences. But when my work is always looked through the lens of cultural humility and cultural humility, if you're not familiar with it, is there are three tenets of cultural humility. So recognizing there is a power imbalance, right? So think about the time that you went to your doctor's office and the doctor sat on the chair and you're on the table so you're not equal. Or maybe they took their white coat off so that it kind of equals or evens out the power imbalance. So just recognizing that there is a power imbalance, the other is recognizing the systemic racism. And then the third one is being reflective of communication. And that's kind of I'd like to think that's my expertise. So being reflective of your communication, so thinking, how do that even on you, on your own, how did that communication go? How did I talk to that patient? How did the patient talk to me, asking the people who you work with. Did I what I communicated with this this patient and their family. Do you think there's room for improvement? And then at times asking the patient, am I asking you the right questions? Am I asking them in the right way? In all of that, those three fit into cultural humility. And that is what the framework of all of my research. And it doesn't. And the reason I like culture humility, instead of just specifically targeting a culture or a race or religion, is that it's even a different upbringing, different lifestyle. So whether you are, again, the rural farmer or a city dweller, whether you have one bathroom in your house or you have six bathrooms, that's going to change. Perhaps the medication that I'm going to prescribe for you, because if I'm going to prescribe a medication that causes nausea and diarrhea, you only have one bathroom, but six people live with you. So let's think about how we can change that so that you're not monopolizing and possibly contaminating the bathroom for everyone who shares your house with you. And so those are things we need patients to share with us, and they're only going to share those things with us if they have a trusting relationship. And so that goes back to that first interaction and that community creating that communication guide to facilitate that trusting interaction. From the first meeting.
PRENTICE: Do you have a time frame for this project?
DOYON: Two years. It's two years. So, the reason why two years? Well, initially when I applied, I was very lucky that I only applied for it's typically a one year or 18 months. They liked my project so much that they extended it and doubled my funding to two years. So and part of that is because I'm using community based participatory research. So CBPR. As I kind of described before, using the community. So I'm using the health care system to inform my research, and I'm using also the refugees themselves. And that's where I want to go. So how do you identify refugees or agencies? I'm just thinking off the top of my head. Idaho Office of Refugees, International Rescue Committee, etc.. Or do you identify refugees who are your who are part of this process for you over the next couple of years and help you build those bridges? And so that's one of the reasons I am so thankful for Boise State, because there are so many other disciplines at Boise State who work with refugees at a different level than I do who are helping me create that those relationships. Because what I bring to the table is the knowledge of communication interventions, hospice and palliative care communication. But recognizing I am not an expert in refugees, and that's why I have the community Advisory board. And there are so many people who have been so helpful at helping me facilitate relationships with people who work with refugees and also refugees themselves, recruiting refugees who, because the ideal participant in my community advisory board in the arm of with the refugees are people who qualify for hospice or palliative care. So this is in hospice and palliative care research. In general, patients are hard to recruit and then layer that with. I would like to have refugees who qualify for hospice and palliative care.
PRENTICE: I've got a really simple question:how is that possible? How do you convince someone who is experiencing that to give you the time of the energy for this project?
DOYON: And that's a great question. I keep asking myself one way is to create a relationship with people. So my community advisory board isn't a traditional I'm going to meet with you once and I'm going to give you $25 for participating in my study and then I will never see you again. The relationship that I enter with community board members is that they are providing a service to their community. So I'm going to meet with them a dozen times at least, and have a relationship with these people so that they we work together. They have an area of expertise that I don't have, and it's a relationship that I hope to actually sustain so that I can keep my refugee community Advisory board and then apply for other grants to help this population.
PRENTICE: And the end product would look like….what would it be? Is it a tangible product?
DOYON: Close to the end product will be the communication guide. So in a perfect world, I will have the communication guide will be a short list of suggestions to facilitate communication. When you when clinicians first have an encounter with a refugee, ideally it's scalable so that we can use this communication guide not only in Boise but in other areas of the United States.
PRENTICE: I'm not sure who's on your community advisory board, but can I assume that because of whoever is on that board that is buy-in for this guide and therefore will help facilitate the distribution of this guide in the community?
DOYON: Yes. So with the Community Advisory Board that's composed of the doctors and nurses, social workers being on the community Advisory board is is the buy in. Again, they bring a level of expertise that that I don't have. I don't work with refugees in the health care setting. So I don't know what I don't know. And that is one of the reasons why I really love using the community based participatory approach, because I need I need my community to tell me where the gap is and what are we missing, and to hear from them, to hear from refugees anywhere along their illness trajectory, to say, If my doctor had said or done this, if my nurse had said or done this, small things. I'm not looking for huge sweeping changes, but communication is foundational. If we don't have that communication from the onset, then patients are not going to share with us what is important to them and then we can facilitate that healthy relationship and get them the person-centered care that we need.
PRENTICE: Dr. Katherine Dolan I. I sense your excitement…and just as a layperson, this is very exciting. Can we sk to touch base with you over the next couple of years? Because this is a pretty big deal for all of us.
DOYON: Well, yes, absolutely. I mean, I would love it. I'm excited talking about my research. Excited. It's I think I'm perfectly positioned to do what I do. All of my life experiences kind of brought me to where I am back from working as a New York City public school teacher all the way to my post-doc and my PhD preparation. And now being here at Boise State is communication is the… it's the cornerstone of all relationships. And if we don't have that, we take that for granted that we're not as clinicians as a health care team. We're not doing our best and specifically going back to refugees now. They shouldn't have to take the time to learn our system, especially refugees who have a serious or chronic illness. And it's to me it's really important. If we could just tweak a little bit of how we do that first encounter with our patients and it has long lasting implications. We need our refugees to feel comfortable and confident, confident navigating our system in order for that to have better outcomes. And that, of course, that's what we want. We want better outcomes.
PRENTICE: She is Dr. Katherine Doyon and Boise State School of Nursing is very lucky to have her. We can't wait to have updates on this. But for now, great, good luck with this. Congratulations and thanks for giving us some time this morning.
DOYON: Thank you. Pleasure to be here. I look forward to our next conversation.
Find reporter George Prentice on Twitter @georgepren
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