Driven to Act: Undergraduate Interns Take On Health Inequities

Health care isn’t always fair, but these student interns hope to change that 

You went to high school? Move forward three spaces. You have no access to public transportation? Move back one space. You developed a substance-use disorder? Move back two spaces.

These are the cards you were dealt, and the rules of this game may not seem fair.

Yet these scenarios—written for a simulation game by two students at the UK College of Nursing—are a part of something remarkable that’s been underway at the College since 2020.

Planting seeds of change with a health equity internship

The Health Equity Internship program launched in Fall 2020 and was supported by the UK Center for Service-Learning and Civic Engagement.

The goal is to help students become effective advocates for equity in groups that have been historically underrepresented and marginalized, specifically the BILPOC and LGBTQ+ populations.

“This generation is going to be creating more equity in health care environments,” says Hartley Feld, PhD, MSN, RN, PHCNS-BC, one of three of the College’s faculty who helped develop the program.

“My hope is that we inspire them to use their voices and not just hope that somebody else does it or think that they’re powerless,” Dr. Feld adds.

The program’s co-founders also hope the focus leads to a more welcoming environment for diverse students in the nursing program.

Facing health inequities in Kentucky and the World

The three-credit-hour internship program currently spans three blocks and includes two track options: LGBTQ+ health, and racial and ethnic justice. An earlier track focused on rural and global care has been integrated into those two programs.

Knowing the disparities and the barriers that many patients face can only improve the care these future nurses give, according to co-founder Megan Walden, MSN, RN.

“It will make them better leaders, as far as being able to challenge what other people say on the units where they work or anything else they see or hear. I hope the students are more empowered to challenge stereotypes or stigma in their settings,” she says.

Walden was inspired to launch the internship at the College a few years ago based on her students’ interest and her own passion for addressing health inequities, concerns and misunderstandings.

She realized it was something Kentucky has long needed, yet even she has been surprised at the response.

“We had more than we ever expected to sign up for the first semester three years ago—and then that doubled by the second semester,” Walden says

Increasing immersion and improving understanding

Anthony Carney, DNP, BSN, APRN, FNP-C, is the third co-founder of the internship program.

“We hope this partnership helps students grow as clinicians and also helps them grow as people who are able to connect with and understand the communities they’ll be serving in their careers,” he says.

Students not only learn about inequities in health care systems, but they also earn service hours by volunteering with Kentucky nonprofits like Black Soil and the Lexington Pride Festival. Their classes also choose relevant films to watch and discuss—everything from Netflix documentaries on indigenous populations to horror films.

“These students have a fierce drive to do this work, and we’ve really enjoyed seeing them grow,” Dr. Carney adds.

MEET THESE STUDENTS

Here are just a few of the interns who are committed to doing meaningful work, along with an introduction to the projects they created:

Ethan Davis

“I’m from a smaller town, and growing up I was in such a bubble. When I finally came to UK, it was like the bubble burst. It was a cultural shock,” says Ethan Davis.

Ethan Davis and Lily Kasey both came to Lexington from small towns in Kentucky; in Kasey’s case, there was just one high school in the entire county. The “culture shock” the two students experienced made them realize how little they knew about people from other backgrounds.

“I wanted to know as much as I could, so I could take care of others the best way possible,” says Davis. “That’s really what drew me to this program, to learn more about minority populations who aren’t treated the same.”

For Kasey, the impetus was growing up in a rural area and seeing firsthand how many residents don’t have access to equitable care, as well as the stigma on expectant mothers suffering from opioid addiction.

“Imagine having a heart attack and knowing you live too far away to get to a cath lab in time. That was my initial interest in health equity, along with a focus on labor and delivery, but I’ve grown to learn so much about every single group and how we can help provide equitable care for everyone,” Kasey says.

When the two were deciding on a project for their internship, they heard from a professor about a board game used for simulation training.

Kasey and Davis identified dozens of situations Kentuckians face every day. They discussed dozens of disparities, both positive or negative, such as living in areas with safe syringe exchange programs and receiving COVID vaccines.

They wrote the situations on game cards. Players roll dice, land on game tiles and draw a card that moves them forward or back.

Davis and Kasey’s game cards will be used as the simulation during their public health semester. 

Ju Eun Kang 

You can read about different groups of people and think you know them, say Ju Eun Kang and Kylie Higgins.

“People are about more than the stigmas they have,” says Higgins. “I feel really lucky that in this internship we’ve gotten to go into communities and see people and know their real character.”

As an international student, Kang was especially concerned about the health issues faced by Kentucky’s immigrant population.

“Then I learned more about how the LGBTQ+ community faces such stigmas, as well as people dealing with drug-addiction disorders,” Kang says. “There shouldn’t be any stigmas; they’re all just people. They just have different stories.”

When it came time for their project, Higgins and Kang reached out to faith-based organizations providing care for people needing treatment for substance abuse. They worked with Voices of Hope, a local recovery community center, to help them identify the best options for those they served.

“Everyone defines recovery differently, so we wanted to look at the resources the faith-based organizations offer, taking into account how faith and spirituality may work for some and not for others,” Higgins says.

“If we were going to refer people to these resources, we wanted to make sure we didn’t refer them to places where they would be stigmatized if they use medication to aid in their recovery,” she adds.

The two developed a brochure that identifies suitable treatment centers, such as Isaiah House, Revive Life House and Addiction Recovery Care, as well as churches that are LGBTQ+ affirming.

Their brochure also included a QR code that they hope people seeking treatment will use to contribute stories of their own experiences. 

Laura Wiedemann 

Everyone has a right to a healthy life, and if they just had the right tools, they could all achieve it, acknowledges nursing student Laura Wiedemann.

“That’s why I wish everyone could learn what we’re learning in our internship program, so all nurses can better meet diverse health needs,” Wiedemann says.

To some extent, she’s getting her wish.

When Wiedemann presented her internship project, she was thrilled to see that students throughout the nursing school attended her presentation. Several faculty encouraged their students to take part.

Wiedemann’s research focused on HPV vaccines, which are needed to prevent infection against some types of human papillomavirus. The virus is associated with most cases of cervical cancer.

Although the vaccines are designed to be given to teenagers or young patients, many parents delay the vaccination or choose not to have their children get it altogether because of the stigma that the virus is often spread through sexual contact.

The problem is made worse for trans or LGBTQ+ young people.

Lesbian women may believe their sexual history means they have no need for vaccination or screenings. Boys aren’t usually encouraged to get the vaccine. Trans people, who are at risk for cervical and other cancers, may fear discrimination from health care providers or suffer from gender dysphoria.

“I focused on the disparities they face, what we have available to treat people with HPV and how can we meet people in the middle who are disproportionately affected,” Wiedemann says.

She adds, “If you went to an elementary school or a high school where abstinenceonly education was taught, there’s a lot of risk that comes with future sexual encounters.”

Wiedemann explored data about educating nurses and physicians to assure that safe sex practices are taught, along with getting a full, inclusive sexual health history.

She also interviewed several health care providers, some of whom told her that in their entire eight years of medical training, they received no more than four hours of training focused on serving LGBTQ+ and BILPOC communities.

What she learned through the project— and throughout the internship—may have changed Wiedemann’s future, too.

“I’d never really thought about going into research before, but I’ve had a great experience with this project, and now I’m thinking about it.”