According to the historical report in the “Angels in white gown” [6], the Korean immigration in the state of Texas started when 43 Korean nurses immigrated to Dallas on April 9th of 1967. The NTKNA is a non-profit organization established in November 1968 by 21 Korean immigrant nurses, working at Parkland hospital in Dallas, Texas [7]. One hundred seventy-eight members have registered to the NTKNA but there are currently only 54 active members, mainly due to various personal reasons such as relocation and no time to volunteer due to family issues.

For more than half a century, the NTKNA members have been serving the Korean immigrant community in North Texas to promote their health through various activities as follow: 1) community-based health promotion educations on various topics including management of chronic disease, healthy diet, perimenopausal symptoms management, self-breast exams, and prevention of depression etc., 2) community medical services such as annual administration of flu vaccines, 3) annual Korean community health fair, 4) health consultations, 5) volunteering at local Korean centers such as Grace Korean Elderly Center, 6) supporting Korean language school for second generation of Korean American children, and 7) volunteering services during other local Korean community events (e.g., running first aid center Dallas-Fort Worth Korean golf day) [8]. In addition, the association is expanding its roles to mentor future Korean nurses in the community and local Korean immigrant nurses who just moved to Texas. It also provides information about graduate nursing education programs, continued education opportunities, available nursing career in north Texas areas, and updated rules and regulations of Texas Borad of Nursing [9].

NTKNA is the oldest Korean American nurse association in the U.S. and celebrated its 50th anniversary in 2018. The association's efforts to improve the health of the local Korean immigrants have never stopped even under the pandemic. In order to timely respond to unmet healthcare needs and promote the health of the local Korean immigrant community amid the COVID-19 pandemic situation, the NTKNA decided to organize the COVID-19 task force team in August, 2020. The team consists of 15 active members including seven critical care registered nurses, two nursing professors, four advanced registered nurse practitioners, two nurse administrators. Serving as a task force team member was 100% voluntarily basis commitment without any financial compensation. The task force implemented two main strategic interventions: Launching the NTKNA nurse hotline service and assisting in online registration for COVID-19 vaccination.

1. Launching North Texas Korean Nurse Association nurse hotline service

After a systematic preparation process to develop the specific operational protocol, the NTKNA's COVID-19 task force team launched the nurse hotline service in September 2020 and the service is still ongoing (Figure 1). It involves the use of electronic communications to enhance Korean immigrants’ understanding of healthcare information, support them to access appropriate health care, and promote self-care by addressing their questions or inquiries. Based on their clinical and educational expertise, 15 task force members were assigned to one of seven specialty categories including adult healthcare, pediatric healthcare, mental healthcare, women's healthcare, geriatric healthcare, home care, healthcare access and local financial resources, and healthcare under the COVID-19 pandemic. The hotline link guides the inquirer to the survey asking the age, sex, e-mail address, category of the health question (multiple choices), health insurance status, and consent to the use of NTKNA hotline service. It also has a blank section to fill out the inquirer's specific questions.

Figure 1
NTKNA Task Force Team to Local Korean Community in North Texas.
NTKNA = North Texas Korean Nurse Association.

• Download Figure

The specific protocols related to the COVID-19 nurse hotline service operation are as follows:

1) NTKNA advertises the NTKNA nurse hotline service in the local newspapers [10] and on bulletin posters at local Korean grocery stores to inform the Korean community of the nurse hotline service link (https://www.surveymonkey.com/r/6Z3KDHR) and its user instructions written in both Korean and English.

2) The hotline service is open to the public during the weekdays from 6:00 am to 9:00 pm and the availability of the service is properly advertised via local newspaper and Dallas Korea radio broadcast station.

3) The NTKNA homepage manager screens the inquiry questions and classifies the question topic of the question from Korean immigrants on a daily basis. The questions are then forwarded to the task force members who are designated to one of seven specialty categories.

4) The task force members who receive the inquiry questions are responsible for responding to questioners and the homepage manager within 24~48 hours.

5) Since this service is provided via electronic communication, the software security protocol of the hotline link was designed to protect the confidentiality of the patient/individual's identification and the consent to the use of NTKNA nurse hotline service was obtained as a part of the hotline service survey.

6) The inquiry submitted via the hotline link will be reviewed by only the NTKNA homepage manager who kept his survey link login credentials as private secure the submitted inquiry data.

The information communicated through the hotline is limited to health education, consultation, and the service and does not include diagnosis, treatment recommendations, or medical prescriptions by the nurse practitioners due to health liability issues. Despite of this limitation, the task force team identified followings as the benefits of receiving the nurse hotline service:

1) A free consultation on specific health issues by health care professionals with educational and clinical credentials in the specific specialty area.

2) Better understanding of medical terms, concerning health conditions, medications (e.g., proper administration, precautions, possible side effects etc.), lab/test results, and/or COVID-19 information and the protective behaviors.

3) Obtaining information on the available healthcare services at minimal or no cost in the community.

4) Obtaining information related to available financial support (fund available provided by county state or federal funds) for the healthcare services.

5) Receiving education related to general measures for health promotion & COVID-19 safety measures including proper handwashing habits, increased physical activities, healthy eating behaviors etc.

When a person accesses the nurse hotline services, NTKNA task force team members implemented precaution measures to minimize potential risk related to the breach of personal health history while using electronic communication software. For example, when the hotline users click the hotline link, they require to read and agree to the possible risks and benefits of this service stated in a short online consent form, which was adopted from Health Insurance Portability and Accountability Act rules and regulations, before they proceed with their inquiry or general questions.

As a method to discuss the efficiency of the hotline service, the NTKNA task force team meets on a weekly basis every Saturday night to review the received inquiries and task force's responses over the prior week as well as to share any issue/concern and to develop strategies to ensure the provision of quality services.

As a professional nursing organization, the NTKNA members has been striving to improve the quality of healthcare, promote networking and fellowship among its members, and contribute to the well-being of the local Korean immigrant community in the North Texas areas. The NTKNA COVID-19 task force team members dedicated a significant time and efforts to timely respond to the healthcare needs of Korean immigrant community members compounded by the extremely challenging pandemic situation. Despite the NTKNA task force team launched the COVID-19 nurse hotline service after considerate process to develop the service protocol, there are couple of important lessons to learn for the task force team.

The inquiries to use the hotline service itself were available only to those community members who have access to or are capable of using a computer/internet to initiate an electronic communication with a task force member. Therefore, the Korean immigrant older adults, who are considered as the most vulnerable population due to multiple chronic health issues, were not able to use the service. Different strategies to improve the hotline access need to utilize alternate resources and formats, for example cooperating with youth group at local Korean church. And the nurse hotline service could be set up during the local Korean community events or on specific dates at local senior centers like Grace Korean Elderly center which provides daycare to them. On the other hand, for those who are young and familiar with internet and social network services, the interactive telehealth format for the hotline service could be utilized as an effective method to provide timely healthcare consultation and education.

The hotline service is still ongoing so we could have more inquiries in the future. However, the number of hotline service users has not been meeting our expectations of having 10~20 inquiries per week. More aggressive public advertising methods using various resources (e.g., weekly broadcasting advertisement through local Korean radio station, cooperation with local Korean church leaders etc.) will be required to reach out more local community members to make sure they are aware of the NTKNA nurse hotline service available to them at no cost.

Lastly, there is still a lack of public awareness toward the professionalism of Korean nurses as reliable health consultants, especially among Korean older adults. In traditional Korean society, the professionalism of healthcare provided by nurses has been undervalued and there was a learned bias that nursing care is inferior to a doctor's care. This viewpoint is still prevalent especially among older Korean adults. However, Korean immigrant nurses in the U.S. are taking active roles as team leaders within the U.S. health care system thanks to their expertise in healthcare knowledge and skills as their professionalism. More aggressive and continuous efforts should be made through proper cooperation with other Korean nurse associations in the U.S. to dispel the prejudicial perception toward professionalism of Korean nurses and their ability to promote the health of the local Korean community members.

Korean nurses who are working in many other foreign countries in the world have had a significant impact on promoting the health of the local Korean communities by actively taking responsibilities as community leaders and by being an inspiring role model to the young Korean American generation. However, their dedications to the communities were rarely reported to the public. This brief case report on the contribution of the NTKNA task force team amid the COVID-19 pandemic is a good example of nursing care excellence by addressing the unmet healthcare needs of underserved vulnerable Korean immigrant community members living in Northern Texas in the U.S.