Although 17% of the population in the United States is Hispanic (U.S. Census Bureau, 2014), only 4.8% of RNs are Hispanic (U.S. Department of Health and Human Services, 2013). These statistics reveal a shortage of Hispanic nurses, compared with the general Hispanic population, which indicates a need to increase nursing workforce diversity to address health disparities in a culturally and linguistically competent manner (Aponte, 2009; Bednarz, Schim, & Doorenbos, 2010). The number of Hispanic nurses involved in research or with a research-focused doctorate degree (e.g., Doctor of Philosophy, Doctor of Nursing Science) is unknown, but the American Association of Colleges of Nursing (AACN) (Fang, Li, & Bednash, 2013) reported that in 2012, Hispanic (5.5%) was the second smallest group enrolled in a research-focused doctoral program, compared with White (72.3%), Black/African American (13.6%), Asian/Native Hawaiian/Other Pacific Islander (6.3%), and American Indian/Alaskan Native/Two or More Races (2.2%). Given that research-focused doctoral programs prepare graduates to conduct independent research and to collaborate by involving others in their research program (AACN, 2006), it is vital to engage and mentor Hispanic nursing students and build research capacity, thereby increasing the number of Hispanic doctoral students in research-focused programs.
Wells and Cagle (2009) reported that most research assistants (RAs) are in graduate programs of study, but they identified the importance of including undergraduate nursing students on a research team to give them access to faculty mentoring, provide insight into the professional role of faculty outside the classroom, develop their communication and collaboration skills, and learn more about research. Wells and Cagle also emphasized the significance of including RAs who represent the sample population, such as bilingual (English and Spanish) Hispanic RAs who could potentially improve the recruitment of Hispanic monolingual (Spanish-speaking only) individuals into research studies and collect data in the preferred language of participants. Wallerstein and Duran (2006) discussed the importance of involving minority graduate students as RAs to reinforce recruitment of minority community members into research studies. Exposing undergraduate and graduate nursing students to research through mentored experiences by becoming an RA early in their education and career is essential to build research capacity among Hispanic nurses and to meet the growing health demands of the Hispanic population. It is essential to engage more Hispanic nursing students into research.
Importance of Culturally Relevant Nursing Research
According to the National Institute of Nursing Research (NINR, n.d.), nursing research is the development of knowledge to advance health, which builds the scientific foundation for clinical practice (e.g., developing culturally appropriate interventions); to prevent disease (e.g., diabetes complications) and disability (e.g., heart attack or stroke); to manage and eliminate symptoms caused by illness (e.g., hypo/hyperglycemia); and to enhance end-of-life and palliative care. Given that nurses are at the forefront of the health care delivery system, nurse scientists are in an ideal position to optimize patient outcomes and services (NINR, 2011).
It is essential to consider culture to provide effective nursing interventions and improve patient outcomes (Aponte, 2012). Culture plays an important role in the health perceptions and behaviors of a given population and, if ignored, can result in a lack of culturally appropriate services (Anderson et al., 2003). For example, Livingston, Minushkin, and Cohn (2008) found that almost one in four Hispanic individuals reported having poor patient–provider interactions and having received poor quality medical treatment because they felt judged due to their financial limitations (e.g., lack of health insurance), race/ethnicity, or accent when speaking English. For these and other reasons, a more diverse nursing workforce that is culturally and linguistically competent and reflects the population being served is crucial. A more representative workforce will be better able to understand the population needs and promote equity in the health care system, while providing patient-centered care (American College of Physicians, 2010; Saha, Beach, & Cooper, 2008). Increased knowledge of the Hispanic culture could result in a better understanding of the root causes of disparities and the creation of more focused research questions that may be effective in eliminating health disparities. For this reason, more Hispanic nurse researchers are needed, and building research capacity is vital.
The purpose of this article is to describe the experiences of five bilingual (English and Spanish) Hispanic female nursing RAs in both undergraduate and graduate nursing education programs and to describe their professional experiences (e.g., novice and experienced nurses) as part of a nursing research team in which mentorship and peer learning were essential components of building research capacity. These students were involved in various aspects of recruitment, data collection, and analysis in three different research projects of a bilingual Hispanic faculty member (J.A.) who was the principal investigator (PI) of two published diabetes-related research studies (Aponte, Boutin-Foster, & Alcantara, 2012; Aponte, Campos-Dominguez, & Jaramillo, 2015) and a third that is being written.
RA Roles in Different Research Studies
Each of the five RAs participated in at least two of three different research studies conducted from 2010 to 2014 with Hispanic individuals with diabetes who were the sample or participants (Table). Before the RAs were hired, each was interviewed. During this interview, they were informed of the aims and purpose of the study and the role and expectations of the RA. After all five RAs were hired, the PI scheduled a meeting for all RAs to meet. The meeting was led by the PI (a tenured Associate Professor of Puerto Rican descent), who provided the RAs with an opportunity to learn more about each other by sharing their nursing and research experiences and their academic plans. This meeting was the first step in creating a peer learning environment among the RAs. The PI encouraged them to support each other, and contact information was exchanged among them. The PI reinforced the importance of mentorship and shared the long-term plan of co-authoring articles and of presenting project findings together at a national nursing conference, always assuring them that they would receive guidance from the PI. At this same meeting, the Farmer and Weston (2002) model was introduced, and articles related to this framework (Cameron et al., 2013; Ried, Farmer, & Weston, 2007) were provided to the RAs. After this initial team meeting and throughout the different studies, the PI communicated with the individual RAs biweekly and hosted monthly team meetings. These meetings occurred either in-person or via conference call.
Research Assistant Demographics and Roles
During the study conducted in 2010, the RA role included recruiting participants, conducting focus groups in Spanish, providing diabetes education in Spanish, and translating and interpreting data collected from the focus groups (Aponte et al., 2012). In the second study that began in 2012, the five RAs worked with the bilingual (English/Spanish) community health workers (CHWs) to improve diabetes outcomes among urban Hispanics with diabetes in a clinic setting. On different days, one of the two registered nurse graduate RAs supervised and provided support to the CHW who was conducting the diabetes educational sessions, offered nursing education to the participants, and made follow-up telephone calls. The other three undergraduate nursing student RAs recruited, made reminder telephone calls, and conducted data entry and literature reviews in preparation for publication of the study. In a third study conducted in 2013 (Aponte et al., 2015), the two undergraduate nursing student RAs recruited participants and conducted individual interviews in English and in Spanish. The RAs explored how Hispanic individuals of the East Harlem community understood, perceived, and experienced behavioral change and maintained such change while managing their diabetes (Aponte et al., 2015).
Through the different studies, the RAs were able to meet and work together. Relationships were also established that allowed the RAs to share experiences as clinicians (e.g., undergraduate nursing student with a novice RN) and as students in advanced practice (e.g., undergraduate with graduate nursing students). Within these different studies, the RAs used their knowledge of the Hispanic culture during recruitment and when engaging potential participants.
The Australian Federal Government identified an urgent need for primary care providers to learn more about research and to integrate evidenced-based knowledge into policy and practice (Ried et al., 2007). This resulted in the Australian Federal Government initiating a call for universities to develop research capacity–building programs. As a result of this government initiative, Farmer and Weston (2002) developed a model that integrates six guiding principles that are essential to developing and evaluating strategies to build research capacity, specifically: (a) a whole-system approach, (b) accommodating diversity, (c) reducing barriers to participation, (d) enabling collaboration, (e) mentoring, and (f) facilitating networking.
Studies have applied this model in the curricula of health professions in Australia and the United Kingdom. For example, an Australian study of medical students who participated in a community-based research project using this model found that the students had an increased research capacity (Mullan, Weston, Rich, & McLennan, 2014). Another study using this model in a service–learning practicum course of speech and language students in the United Kingdom reported an increased research capacity (Whitworth Haining & Stringer, 2012). Although no published studies on the use of this model in the United States were found, the model can be applicable to any health professions discipline.
The Farmer and Weston (2002) framework includes key principles that underpin the components of capacity building, mentoring, and collaboration; for that reason, the framework was used in the current study. The use of the framework among the nursing RAs in the research projects is described in the current article. The RAs were asked to keep reflection journals. Quotations from these journals, describing how the RAs applied these guiding principles while participating in these research studies, are presented.
The first principle—a whole-system approach—allows practitioners at any stage of their career and educational development to engage in the research process and advance to a higher level of learning research by observing and understanding the process through the hands-on experience.
Several reflections demonstrate how this principle was applied:
- At first, I thought my lack of knowledge in the research process would not qualify me for the opportunity. However, I learned that no expertise, knowledge, or prior experience in research is needed, except for a good research experience. (Undergraduate nursing student)
- Participating in this research study gave me the opportunity to apply the skills and knowledge I gained while in school, as well as reinforced the experiential knowledge I gained as a home care nurse. It also allowed me to gain insight on how research improves the communities I serve. (Graduate nursing student)
- I am passionate about community nursing, and in the two projects I worked on was able to learn more about community research and apply my knowledge. (Undergraduate nursing student)
- When I started as an RA, I was taking a nursing research class and was becoming more and more interested in research and greatly appreciated the opportunity to be an RA and practice research. (Undergraduate nursing student)
The second principle—accommodating diversity—refers to the differences in research interests, professional backgrounds (i.e., nonnursing, home care, acute care, oncology), clinical practice (i.e., nonnursing experience, novice and experienced nurse), educational level (i.e., undergraduate and graduate), and learning styles of all practitioners. Given that primary care settings are multidisciplinary, each discipline is diverse—at a different stage or level of building research capacity—and may have different research interests and needs, making it essential to acknowledge diversity among providers and accommodating it.
Although all five RAs were nursing students and not of different disciplines and they had a similar research interest—improving the health of the Hispanic population—they were diverse in their clinical practice, level of education, and ethnicity. The RAs found that being Hispanic, but from different countries, such as Mexico and the Dominican Republic, was an essential part of accommodating diversity while conducting research with a diverse sample of Hispanic individuals with diabetes. Given that the RAs were Hispanic and bilingual, they were able to meet the research samples’ linguistic needs by being able to speak in English or Spanish at the request of the research participant. They were also knowledgeable about different Hispanic cultural foods, which assisted them to teach about the unique characteristics of different foods when discussing diet and nutrition. Three reflections highlight this principle:
- By understanding the culture, food, myths, and fears of Hispanic [individuals], I was able to provide compassionate, empathetic, and culturally competent care to the Hispanic population. (Undergraduate nursing student)
- Someone from Mexico will have different beliefs in health management than someone from Argentina, Ecuador, or Puerto Rico…. We cannot generalize every Hispanic patient; instead, by respecting differences and listening to our patients, we can gain a better understanding of what is important to them and tailor their health experience…. In collaborating with the other RAs, we realized we represented different Hispanic backgrounds that added a richer dimension of how we incorporated culture when communicating with study participants. (Graduate nursing student)
- Being a Hispanic RA greatly helped me achieve said goals [to find out more about the daily lifestyle of Hispanics with diabetes, their level of knowledge concerning their diabetes, and the lifestyle choices they have made after being diagnosed with diabetes] because it helped me closely relate with the participants and anticipate their needs and concerns. (Undergraduate nursing student)
The third principle—reducing barriers to participation—involves identifying and overcoming the many existing barriers that prevent research capacity building. For the five nursing RAs, this principle applied to allowing the nursing student to participate in the conducting of research studies by making resources (e.g., money to pay for an RA) available that can help aid in the research process. For example, by making a compensated position (i.e., RA) available to the research team, additional potential participants can be contacted and participant recruitment is facilitated, with the RA explaining the study and the participant’s role as an individual who shares a similar culture and language. Four quotations from the reflective journals highlight the application of this principle:
- …[RA position] providing a paid opportunity for students who are interested in research to get paid while studying [in a nursing program]. This was a very beneficial outcome because as a full-time nursing student with a demanding schedule, [it provided] an opportunity to earn some money. (Undergraduate nursing student)
- Every time a faculty member needs help in research, the secretary of the nursing program sends out an e-mail to all students telling them about the opportunity, which is a great way of getting students involved with research. (Undergraduate nursing student)
- Working with the same peers and maintaining a close relationship with our mentor has helped me understand the research process better [and] interact better with others (the team and participants alike), and [it] has exposed me to opportunities that most RAs are not exposed to. (Undergraduate nursing student)
- Having a position that has flexible hours [during] graduate school and working as a nurse allowed me to take this RA position. (Graduate nursing student)
Enabling collaboration—the fourth principle—refers to enabling collaborations in research-capacity building. Collaborations could occur among multicenters and public and private sectors working on projects together or between students and faculty, which are all important ways to build research capacity. During the projects of the five nursing RAs, enabling collaboration was the interaction of different members of the research team, either among the sample professional group or multidisciplinary team members. In the different studies, the RAs collaborated among themselves or with institutional review board members, CHWs, and staff members of senior centers. These interactions allowed for the RAs to learn about the role of others in research and to share interests and experiences with each other, providing a way to foster teamwork and partnerships, which is essential to ensure project success. Four quotations reflect the extent of that collaboration:
- Between the other RAs, CHWs, and IRB [institutional review board] personnel at the facilities, we worked together well, since the IRB staff had a large role in our success…. The IRB staff in the facilities [where] we conducted our studies were responsible for reserving rooms in order to conduct focus group sessions and provided us with the necessary equipment to facilitate the educational classes, such as computers, [and] introduced, oriented, and directed us around the facility…. As a result of collaboration [among] the RAs, research capacity building occurred…during our team meetings…. RAs facilitated communication between and among IRB staff and the CHWs. Additional collaborative efforts and research capacity-building situations occurred among the RAs, including writing an article together, submitting an abstract for a presentation, and presenting together at a national nursing conference. (Undergraduate nursing student)
- There was also collaboration among the RAs and the CHWs who led the educational classes. Hearing how the CHWs were able to explain and dissect educational concepts in a manner the participants could understand was invaluable qualitative data that could have only been collected [by] being an observer in the room. In addition to the RA learning from the CHWs, the CHWs also gained an increased knowledge base on diabetes, as well as increased teaching skills that they can carry throughout their roles. Last and most important, collaboration [occurred] with the community we served. (Graduate nursing student)
- Another RA, our mentor, the senior center staff, and I worked together to look for Hispanic participants in an effective, efficient, and succinct way to recruit them [into] the study, which helped us to better understand the needs and concerns of this community. (Undergraduate nursing student)
- Collaboration incorporates communication with the research team (PI, RAs, IRB members, CHWs, and participants).… In discussing delegation of responsibilities, such as partaking in the consent process, observing classes, and gathering information, enhanced the collaboration process since ideas, knowledge, and skills are shared at each step; discussions among the RAs, PI, and CHWs on lessons learned from the study, ways to more effectively educate the patients, [and] purpose of the home and supermarket visits, helped us to collaborate more efficiently. (Graduate nursing student)
The fifth principle—mentoring—is when the academic mentor provides feedback, guidance, and encouragement to the mentee as a way to increase research skills. Byrne and Keefe (2002) defined mentoring as a “way to transfer knowledge…for the dual purposes of career development and the enhancement of the profession” (p. 392). Mentoring is one of the primary ways for one generation to teach and share its knowledge with future generations. A mentoring relationship entails trust and a commitment from both the mentor and mentee (Bettmann, 2009). Through mentored hands-on nursing research experiences, mentees have opportunities to apply and practice research methodology learned in the classroom, can participate in the many steps of conducting research (e.g., recruitment, data entry, conducting focus groups), see the outcomes of the intervention and results of the study, and participate in the dissemination of the findings (e.g., publication and presentation). These experiences provide a comprehensive research exposure to the multiple research facets and enhance a mentee’s understanding of research.
Peers can also mentor. The literature on peer learning among graduate students or between graduate and undergraduate students is scarce. A literature review on peer learning among undergraduate nursing students indicated that 16 of 18 studies found peer learning to be an effective method to develop skills in communication, critical thinking, and self-confidence (Stone, Cooper, & Cant, 2013). Students were also found to share information and knowledge and to give each other advice and guidance, which reduced their anxiety associated with learning. The literature review also showed that the social interaction and collaboration among peers contributed to them having better outcomes (e.g., learning more and having an increase in knowledge), compared with those who studied independently. Peer learning occurred during interactions and experiences with each other as team members on the research projects. Five quotations highlight the importance of mentoring:
- It was very important for our mentor to make sure that [the] RAs understood every aspect of her research so that they could get a general understanding of the people behind the data [that] they were entering and understand the project… Having a supportive mentor provided me [with] the hands-on understanding of nursing research, encouraged me to participate in research even when I was unsure, inspired me in becoming a mentor, [and was] a role model that facilitated learning, provided guidance, and constructive feedback…while encouraging growth, such as inspiring me to co-author [the current] article and co-present at a national nursing conference. (Undergraduate nursing student)
- Pairing a novice with an experienced RA peer and/or mentor, such as [that which] happened with our team, taught me the research process and significance of research in nursing.… This peer learning experience has allowed us to give each other support, encouragement, [and] personal and academic advice; it has even motivated me to further my education, pursue my master’s [degree] in nursing, and participate in other research activities. (Graduate nursing student)
- The PI and mentor immediately saw my strengths and pushed me to work to my fullest capacity, while she also saw where I struggled and took every moment as a teaching moment, which allowed me to succeed in my role as RA. This experience has given me the opportunity to co-author an article on the project we worked on, [which is] something not all nursing students have the opportunity to be a part of and achieve. (Undergraduate nursing student)
- Being mentored has given me clarity on how research is carried out and [has] ignited a passion to meet community needs through research.… Our mentor is a source of encouragement to all her RAs…. She patiently explained each and every step of the research process in a way that made it easily understandable [and] increased my desire to become further involved in nursing research.… Her guidance to reflect what we are doing at each step and its significance for the research and for the community itself is inspiring and encouraging and makes me want to be a mentor and researcher. (Graduate nursing student)
- By being an RA, this experience and mentorship has allowed me to learn more about my Hispanic community, the difficulties one must overcome when conducting research, and the potential benefits of research. (Undergraduate nursing student)
Facilitating networking—the sixth principle—entails strategies that aimed at professional development. The five nursing RAs were encouraged to become members of a national nursing organization. As members, they were able to participate and present at one of the conferences of the organization, as well as networking at the conference. These types of networking opportunities can build capacity. The following three quotations demonstrate the diversity of networking between the RA and the national nursing organizations:
- Presenting at a national nursing conference and sharing what I learned during this RA experience allows me to share the knowledge gained about research and encourage other nursing students to become RAs, and other nurse educators and researchers to consider creating such opportunities for their nursing students. (Graduate nursing student)
- During this experience, I was encouraged to become a member of the National Association of Hispanic Nurses, and through membership meetings, I [met] other nurses. (Undergraduate nursing student)
- Presenting with our mentor at the national nursing conference allowed me to share the research findings to other nurses from all over the country and other members of our multidisciplinary team, and share research interests with others. (Graduate nursing student)
To identify and meet the needs of Hispanic individuals, it is essential to use innovative ways to engage them and enroll them to participate in research studies (Caban, Walker, Sanchez, & Mera, 2008). As the Institute of Medicine’s Future of Nursing (2010) reports, a need exists for nurses to advance the profession and take a greater role in the health care system to meet the demands and needs of the patient population it serves. The integration of Hispanic nursing students (i.e., undergraduate and graduate) into research experiences and peer-learning research activities has enhanced the desire of Hispanic undergraduate students to advance their education to graduate school and to consider becoming mentors. Hence, the types of research activities the five RAs were part of can potentially be a way to increase the number of Hispanic nurses advancing their education (e.g., to obtain master’s or doctorate degrees), becoming role models, and joining the nursing workforce.
The faculty mentor, who also was the PI in the three research studies, encouraged the five RAs to coauthor articles, and the five RAs have either published or are currently working on publishing an article with the PI.
More Hispanic researchers need to accept the challenge of becoming a mentor. Mentoring and teaching Hispanic undergraduate and graduate nursing students about research and encouraging them to get involved in research early in their career could result in greater participation of Hispanic individuals in research. Simultaneously, this could also result in building research capacity and in Hispanic nursing students becoming interested in pursuing higher degrees and closing the gap between the ethnicity of the U.S. population and the RN workforce.
Finally, academic settings need to develop a way to provide hands-on research opportunities for students that allow them to gain the skills, confidence, and knowledge related to research. As the five Hispanic nursing students’ reflections revealed, providing paid RA positions that offer flexible hours to allow them to be active research participants can be an effective mechanism for building research capacity.
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Research Assistant Demographics and Roles
|Undergraduate student||Mexican descent||Recruited participants; assisted with conducting focus groups in Spanish; provided diabetes education; translated and interpreted focus group data.|
|Supervised and provided support to the community health workers (CHWs); offered nursing education to the participant; made follow-up telephone calls.|
|Undergraduate student||Colombian and El Salvadorean descent||Recruited participants; made reminder telephone calls; performed data entry; conducted literature reviews.|
|Recruited participants; conducted individual interviews with participants.|
|Undergraduate student||Ecuadorian descent||Recruited participants; made reminder telephone calls; conducted data entry; conducted literature reviews.|
|Recruited participants; conducted individual interviews with participants.|
|Graduate student||Dominican descent||Supervised and provided support to the CHWs; offered nursing education to the participants; and made follow-up telephone calls.|
|Graduate student||Ecuadorian descent||Supervised and provided support to the CHWs; offered nursing education to the participants; made follow-up telephone calls.|