Journal of General Nursing and Community Health

Volume 1 Issue 1

Interprofessional Care of Refugees: Preceptor Narrative on Trust

Figueroa April*, Febles Carmen**, Nies Mary A***

College of Nursing
Idaho State University
Corresponding author’s email id: niesmary@isu.edu***
DOI: http://doi.org/10.5281/zenodo.3739196

Abstract
Interprofessional Teams and culturally congruent care are well-
established and well-documented priorities across contemporary U.S.
medical practice. The Conceptual Model for Home Based Primary Care
of Refugees proposes a paradigm for the provision of culturally safe care
through the interprofessional team framework. The purpose of this paper
is to describe one nurse preceptor's experience while serving as a
preceptor for student home visits to refugee homes

Keywords: Preceptor, Refugee, Narratives, Interprofessional

INTRODUCTION age and older). Students guided by a

The Idaho Senior Refugee Interprofessional
Holistic Health Project provides education
and first-hand experience for students of
Nursing and related health disciplines. The
education emphasizes the provision of
culturally sensitive, interprofessional care
in the home setting. Students and faculty
from several disciplines, including
advanced practice nursing, pharmacy,
audiology, and dietetics provided care to
senior refugee’s in their own homes,
including health screening, assessment and
education for the older refugee (50 years of
preceptor incorporate face-to-face and
remote conferencing collaborations
between team members. Through these
home visits, Interprofessional (IP) teams
provide health assessments, health
screenings, community resource support,
and communication back to primary care
providers. The experience provides a
unique hands-on experience working with
limited English proficiency in a home visit
setting. Key to the project is the integration
of interpreters as part of the IP team to
provide linguistic support, and to facilitate

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the cultural interaction between refugees
and practitioners.
The project is premised on the efficacy of
the IP teams in providing holistic quality
care [1-3]; as well as on multi-disciplinary
literature that establishes the positive
outcome impact of culturally
linguistically responsive care for refugee
populations, and the inclusion of trained
interpreters as part of the care team for
individuals with limited
proficiency [4-7]. The goal of the project
was to prepare students for caring for
diverse individuals by providing a hands-
on, immersive interprofessional working
experience that integrates the components
of culturally and linguistically responsive
care to serve a high-needs, at-risk refugee
population.
PURPOSE
The purpose of this paper is to describe one
nurse preceptor´s experience
narratives while serving as a preceptor for
the student home visits to refugee homes.
Narratives are open-ended reflections,
framed as “perspectives”, in
participants are asked to reflect individually
on challenges, strategies and lessons
learned from first-hand participation in the
project. At the outset of the project, a
Conceptual model for Home-based care of
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Journal of General Nursing and Community Health
Volume 1 Issue 1
refugees was developed [2]. The
Conceptual Model for Home-based care of
refugees takes as its point of departure
cultural safety [8-10] as a key factor for the
establishment of trust between refugee and
practitioner. A second key input for
establishing trust is Linguistic
and communication, understood as the
successful overcoming of barriers to
spoken communication between refugee
and practitioner [11-13]. The third input is
English the implementation of the Interprofessional
Team model of care to ensure that refugee
needs are being considered and met
holistically, and that experts addressing
refugee needs are working from within their
specific frame of expertise. The model
postulates that the three inputs facilitate the
development of trust between the refugee
and practitioner. The model further
postulates that a trust relationship is
positively related to improved health
outcomes, improved patient quality of life
using and improved practitioner collaboration.
METHODS
The preceptor provided reflections and
which perspectives for the narratives in this paper.
Doctor of Nursing Practice (DNP) students
under the supervision of a Nurse Preceptor
participated in a grant-funded project that
provided home-based primary care to
refugees. The preceptor and students in the
 Journal of General Nursing and Community Health
project received a basic introduction to
cultural safety practices, and some
preparation for working with interpreters.
The project staff previously published
perspective narratives provided by DNP
students [14].This paper discusses the
Nurse Preceptor perspective to continue to
evaluate the usefulness of the key inputs
from the practitioner viewpoint, as well as
to gather some anecdotal evidence from the
preceptor regarding outcomes as they relate
to the proposed inputs in the conceptual
model. The current paper provides the point
of view of a doctorally prepared advanced
practice nurse from the practitioner
perspective. The perspective is that of the
lead preceptor on the project, who had the
most consistent schedule and the lead role
in overseeing student participants. Future
studies will evaluate quantitative data to
assess patient outcomes, and observable
measures of practitioner collaboration. This
paper examine the preceptor’s narrative
with the conceptual model developed for
home-based care for refugees [2].
DISCUSSION
The three key inputs theorized in the
conceptual model for the home-based
primary care of refugees is Linguistic
communication, Cultural safety, and IP
Team [2]. The model theorizes that the
coalescence of the three inputs leads to
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Volume 1 Issue 1
trust, which will yield improved patient
health outcomes, quality of life, and
improved practitioner collaboration. The
narrative perspective from the preceptor is
noteworthy in that the experiences align
with the input proposed in the conceptual
model, suggesting that from the preceptor
perspective, the experience of providing
home-based care to refugees corroborates
the factors leading to the establishment of
refugee/practitioner trust.
Linguistic communication
The preceptor narrative speaks to the
significance of overcoming the linguistic
barrier between refugee participants as key
to the successful delivery of quality care. In
the project in which the preceptor
participated, linguistic communication was
facilitated with trained interpreters who
shared the refugee’s culture of origin. The
use of trained and culturally knowledgeable
interpreters has broad evidence-based
support as a method of addressing linguistic
barriers between patients and practitioners
[15-18]. The preceptor narrative supports
the essential role of the interpreter in the
communicative process, and the significant
role that the interpreter plays in easing
anxiety and tension around the interactions
from the practitioner point of view.
Specifically, the preceptor narrative
directly credits the interpreter as a purveyor
 Journal of General Nursing and Community Health
Volume 1 Issue 1

of trust to the refugee/practitioner safety is an evolution of cultural

interaction: competence that advocates for the
recognition and validation of the refugee’s
I knew when starting as preceptor that our culture as an integral part of their being, and
interpreters would be valuable to this therefore their physical and mental health,
experience, but I assumed that their value rather than as an obstacle that must be
would be limited to their expertise in understood in order to be overcome by the
language interpretation. I didn’t anticipate practitioner [9, 10]. The preceptor
their expertise in the cultural experience, eloquently speaks to her personal
the utilization of community resources, and experience with this evolution in a practical
the element of trust they lent to the IP team. context, and to the role of the linguistic and
In this setting and with this specific cultural broker (the interpreter) in making
population of refugees, I did not anticipate possible the shift from the cultural
how much harder it would be to gain trust. competence model to the cultural safety
I quickly learned that our interpreters model:
provided the initial trust component that our
team needed to be welcomed into homes The experience through this project
and to be allowed to provide our services. unexpectedly supported that cultural
approach, and our interpreters served as a
This narrative speaks to the role of the valuable cultural guide for everyone on the
interpreter in establishing trust with the IP team as well as the refugees.
refugee, as well as the fundamental role of
the interpreter as cultural broker vis-a-vis As a teacher and experiential guide, she
linguistic interpretation. recognized the role of interpreters as
cultural teachers in the interactions, giving
Cultural Safety the student participants something that even
Varying terminology (cultural sensitivity, she herself could not, valuable insight and
cultural awareness) is used to speak to feedback into the cultural aspects of the
knowledge about, and experience with, interactions they were having.
caring for individuals from an unfamiliar
cultural context. However, the preceptor Interprofessional Team
narrative provides a shift towards an The preceptor narrative notes that for both
understanding of cultural safety. Cultural her and the students, the IP team component

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 Journal of General Nursing and Community Health
of the project was the most challenging to
implement.
I anticipated the interprofessional student
collaboration would be valuable in this
project. While I anticipated scheduling and
interaction between interprofessional
students from five different rigorous
academic programs would be challenging,
it was not until I actually experienced this
that I fully appreciated these challenges.
One specific challenge was variation in
student participation and how to support
regular IP team collaboration. Specifically,
finding a platform for which all student
input was allowed equal opportunity, and
one in which students felt that they were a
team participant, even if not actually
attending home visits.
The project design initially attempted to
support this interaction with a combination
of face-to-face informal conferencing
outside the refugee’s home before and after
each home visit along with an online
learning platform discussion board over the
following days and to allow for discussion
of the home visit experience and to develop
a collaborative plan. We found the face-to-
face informal conferencing limited
interactions to those participants at home
visits, sometimes leaving out more than
half of the IP team. This process was a
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Volume 1 Issue 1
good attempt at teamwork in a unique
interprofessional outpatient home visit
setting, however it fell short of supporting
whole team collaboration and
communication in a timely manner.
In addition, the preceptor was able to relay
that the challenges with the initial IP team
meeting system were addressed, with
anecdotally positive effects:
The collaborative design evolved so that
face-to-face conferences were replaced
with video conferences the morning and
evening of home visits. During morning
video conferences, each refugee was
presented and a collaborative plan was
developing using interprofessional
expertise and consultation
recommendations. During evening video
conferencing, the team reviewed each
refugee home visit and developed a
collaborative care plan with
communication recommendations back to
the primary care provider. Conferences
also served as a platform for
interprofessional education on home visit
and cultural-specific experiences at home
visits and allowed for clinical discussion
relevant to home visits and each discipline.
The preceptor perspective speaks to the
importance of strategic design in the
implementation of an IP team model, and to
the challenges that such a task present.
 Journal of General Nursing and Community Health
Volume 1 Issue 1

However, the members of the IP team care encounters with refugees. Likewise,
considered the goal worthy of persistence, the project preceptor emphasizes in her own
and ultimately found a productive method narrative the preeminence of the lessons she
of collaboration. learned about the practical challenges and
rewards of providing culturally and
In addition, it is important to note that all linguistically responsive care in a
of the narratives speak to an increased healthcare system driven by time
understanding and appreciation of the constraints and automation.
role of the interpreter as a member of the
IP team, and each speaks to the way in TRUST
which that role facilitates the development The conceptual model [2] hypothesizes that
of a mutually respectful the coalescence of linguistic
refugee/practitioner interaction. The communication, cultural safety and IP team
preceptor perspective affirms that: lead to trust. Preliminary narrative evidence
Our students often knew of the resources indicates that from the practitioner
that we should recommend or guide our perspective, the incorporation of all three
refugees toward, but our interpreters were elements, does lead to increased trust.
able to provide valuable tips and Anecdotally, the preceptor narratives also
recommendations for optimizing these indicate heightened empathy and indicate
resources; their expertise is similar to that an increased awareness of their refugee’s
of clinical preceptors, providing an challenges in navigating the US healthcare
experience-based set of expertise that can system. The preceptor observed that: “By
be missed in didactic education. far, the most valuable lesson I have learned
is a better understanding of the disconnect
When relaying the impact that their between intended healthcare and the reality
participation had on them as practitioners of delivered healthcare.” Specifically, she
and as people, the students routinely cited speaks to the types of systemic challenges
experiences and lessons related to cultural refugees face when negotiating the US
learning including working with healthcare system:
interpreters, overcoming anxiety and
insecurity, learning to cope with language The experience through this project
and cultural barriers, and a sense of unexpectedly supported that cultural
professional growth as a result of the home- approach, and our interpreters served as a

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 Journal of General Nursing and Community Health
Volume 1 Issue 1

valuable cultural guide for everyone on the on that trust in my professional practice. In
interprofessional team as well as the this setting and with this specific population
refugees. of refugees, I did not anticipate how much
harder it would be to gain trust. I quickly
The preceptor, as well, speaks to the learned that our interpreters provided the
palpable impact of the interpreter as initial trust component that our team needed
cultural broker in the home care to be welcomed into homes and to be
interactions: allowed to provide our services.

Students relied on the interpreters to guide Interpreters were also an unanticipated

them in cultural practices in the homes as expert in community resources. While I
well as provided education and supported expected our students to provide a wealth of
discussion in conferences on the knowledge on community resources based
significance of these cultural practices. on the varied clinical experiences they had
Additionally, just as I provide clinical through their academic programs, I did not
feedback to students after home visits, our anticipate the level of expertise our
interpreters provided feedback to students interpreters provided.
on cultural interactions that occurred.
Furthermore, the home based setting in
Ultimately, the preceptor summarizes how which care occurred shifted the balance of
the Interprofessional Team approach power, placing the preceptor and student in
allowed for the interpreter to be integrated the refugee’s environment. The preceptor
into the healthcare team as both a linguistic notes that the intimacy of the home-care
facilitator, and a cultural broker. The setting:
preceptor acknowledges that the integrating The intimate home-care setting provides
of cultural and linguistic support as core the project participants unusual access to
facets of the interprofessional team information about the day-to-day lives of
ultimately facilitated the establishment of refugees.
trust between the refugees and
practitioners: The preceptor’s narrative coincides with a
broad body of literature in her conclusion
Nursing is often rated as one of the most that the presence of a culturally proficient
trusted professions, and I know that I rely language interpreter clearly facilitates

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 Journal of General Nursing and Community Health
Volume 1 Issue 1

heightened trust on the part of the That said, preceptor narratives provide
practitioners both in themselves, and for valuable information about the key inputs
those they care for [1, 8, 7, 10, 11, 19, 20]. of the conceptual model on the nurse
The increased trust and improved preceptor overseeing the home visits. The
communication in turn open up practitioner learning reflected in the
opportunities for discussion of challenges narratives is promising for future care of
faced by refugees that lead to breakdowns linguistically and culturally marginalized
in compliance with medically individuals going forward.
recommended self-care. The increased
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