Kierkegaard said, “Once you label me, you negate me.” And, so it goes for the many labels we unwittingly assign people in our health care interactions. Those affected by homelessness, who are often labeled as “the homeless,” are no different. People are not their circumstances and as nurses we want to support a forward momentum out of unhealthy situations. Here are 10 ways you can help.
1. Change the language.
Anchoring someone down under a label creates the risk of someone officially taking on that label and identity permanently. It’s time to change the language so that those affected by a circumstance or condition are upheld in the energy of transitioning into a better outcome.
2. Offer frost bite checks in the streets and the shelters.
When I was a city hospital war horse, I took care of more post-operative amputations than seemed reasonable. Many were individuals who experienced one bad night out there on the streets. Frost bite is a killer of digits, ear lobes, and limbs. As we know, prevention is best and early treatment is second best. It can be a slower row to hoe toward amputation from peripheral vascular disease, diabetes, and wound infection.
3. Offer foot gear.
Start a boot and shoe brigade. Foot gear needs to be protective. The average person affected by homelessness walks five miles per day. Even those who stay overnight in shelters cannot stay there during the day. It’s out into the elements in the morning. Try doing that in lousy shoes or boots and paper thin socks. Offer shoes and boots at the shelters and neighborhoods that have been identified as areas of need. Enroll some shoe outlets and podiatrists to set up a “give away” table in neighborhoods of high need, announce a foot gear day at the local church or community center. Shoes don’t have to be new; however, be kind and do not donate anything you would not wear yourself. Dignity needs to be a part of the equation.
4. Offer foot care clinics at shelters or request to use space at a church or community center.
This can be a great monthly event among nurse friends. You can check for peripheral vascular symptoms, diabetic ulcers, the need for nail trimmings, wash feet, moisturize, offer clean socks, and recommend appropriate medical follow-up. Folks are having it hard enough without adding a missing limb to the mix. I became a WOCN board Certified Foot Care Nurse (CFCN) and travel with my nail trimming tools as part of my amputation prevention initiative.
5. Provide socks.
In the winter, wool cotton socks go a long way at preventing frost bite. The wool cotton hikers found in multi-packs at Sam’s Club or BJ’s have been a great resource for my work. While you’re at it, throw in some winter hats, gloves, and scarves. In the summer, give them cotton blend, moisture-wicking socks with comfort cushion. Remember, there is a lot of walking within this population. Throw in some fabric band-aids for blisters.
6. Give them coffee shop cards.
This will get someone out of the elements and into a place where they are a paying customer. Whether it’s the heat of the summer or cold of the winter, imagine being outside and just wanting to sit somewhere out of the extremes. In New England, we use Dunkin Donuts. Five dollar increments prevent folks from mugging each other for a higher value item. Bear in mind, it can be like Mad Max and the Thunderdome on the streets.
7. Donate feminine hygiene products.
Women affected by homelessness get menstrual cycles. It’s tough going enough without dealing with the need for pads, tampons, and wipes. Donate feminine hygiene products to shelters, offer feminine hygiene products in “benevolent baggies” (see #9). Offer neighborhood pharmacy cards so a woman can choose her own products.
8. No judgement, just help.
Do conscious inner work to extinguish the urge to judge what brings a person to be without a permanent residence. There are married couples who both work full time but still cannot afford to pay rent; there are those who served to protect your freedoms in the military who are now affected by PTSD and cannot support themselves; there are children born into extenuating situations; and there are those who find it safer to be on the streets instead of shelters, and if you knew more, you would understand why. There are those with mental health and addiction issues. While I was offering foot care at a shelter, I learned of a fellow nurse staying there. He was in a terrible car accident, had spinal fractures, could not work, and lost his apartment due to an inability to keep up with the rent. The circumstances are as individual as the person. Take time to listen; everyone wants to be known. When we care for others within compassion, we care for ourselves.
9. Offer “benevolent baggies.”
If you see someone panhandling and you don’t want to offer cash, benevolent baggies (as I call them) are a way to go. You can include whatever you personally would appreciate if you were humbled to having to stand on the street and ask for immediate help. Use a small or large freezer weight Ziploc bag, which works better for those on the street. You can include a coffee shop card, neighborhood pharmacy card, snack bar, water, socks, underwear, feminine hygiene products, a quote you find inspiring that may encourage someone else. I keep a small stack of $5 Dunkin Donuts coffee shop cards in the center console of my car. I know many feel uneasy about giving to panhandlers. I hope this will put it in perspective for you: A woman once said, “I would rather panhandle than sell my body or steal.” Let’s all work toward a healthy society where people do not have to make these types of decisions.
10. Work for social change.
Pick any piece of this huge puzzle and go for it. Ask yourself the bigger questions about this issue. Jump on an initiative with some integrity or start your own. You are smart, caring, and a creative problem solver. You’re a nurse who can facilitate healing far reaching into the community. You don’t need any formal permission to bring that to the world.
The University of Alabama at Birmingham (UAB) School of Nursing has been partnering with community agencies to serve the health care needs of underserved populations across the state for many years. In 2013, the UAB School of Nursing Foundry Clinic was created at The Foundry Rescue Mission and Recovery Center in Bessemer, AL. They have also partnered with Cooper Green Mercy Health Services and Aletheia House to provide substance abuse treatment and HIV prevention education to low-income neighborhoods.
Now UAB Nursing is expanding their partnerships to include the Bessemer Neighborhood Health Center as a New Access Point Federally Qualified Health Center by the Health Resources and Services Administration (HRSA). The funding is to help improve the health of underserved communities across the country by increasing access to quality primary health care services. HRSA awards the two-year, $1.4 million grant to 75 institutions, and UAB’s grant was one of only four awarded in Alabama.
UAB strives to provide a full range of primary care to patients at both of its partnership clinics. Patients are able to receive blood pressure management services, diabetes management, treatment of acute illnesses, access to lab facilities, and help having prescriptions filled. Providing these services in their nurse-managed clinics allows underserved communities to receive competent care, increasing the likelihood that these patients will seek the care they need.
To learn more about UAB’s partnership clinics, visit here.
March of Dimes celebrated their 4th annual “Nurse of the Year” awards banquet last week in Ohio, honoring Debbie Borowske, DNP, RN, GCNS-BC, as their Nurse of the Year. Borowske was recognized for her work in long-term acute care, rehabilitation hospice, and palliative care as the director of Post-Acute Care Services at Southwest General Health Center.
After finding a gap in the hospice services offered by Southwest General, Borowske launched a community-based palliative care program which sees an average of 50 patients per month. Her program consistently achieves its goal of improving life and providing comfort to those with serious, chronic, and life-threatening illnesses. In addition to her work at the health center, Debbie also holds adjunct faculty positions in nursing at Case Western Reserve University, Malone University, and Kent State University.
The annual March of Dimes Event recognizes exceptional nurses, creates awareness of professional excellence, and promotes the future of nursing helping to advance their mission to improve the health of babies by preventing premature birth, birth defects, and infant mortality. To learn more about Debbie Borowske and her Nurse of the Year recognition by March of Dimes, visit here.
Katelyn Nordhoff, 22, a junior nursing student at Indiana University, didn’t realize how few kids in nearby low-income neighborhoods receive regular dental care twice a year until she began a community clinical course this semester. The course is designed to teach students about health disparities in rural and low-income areas.
To complete her community hours, Nordhoff was stationed at Bloomington Housing Authority providing basic health screenings. She began to see a disparity in dental care especially after learning that many families she saw didn’t have normal health insurance, and even those with health insurance didn’t have dental coverage. Referring to dental care, Nordhoff told the Bloomington HeraldTimesOnline.com that, “It’s kind of something you don’t even think about when you think of health care.”
While working with kids from kindergarten through 4th grade, Nordhoff saw the effects of not visiting a dentist twice a year. Many of the kids hadn’t even been to the dentist twice in their lives. Wanting to help teach these young kids the importance of brushing and flossing twice a day, she asked for donations from local dentists and received enough materials to put together 175 dental kits with neon toothbrushes, toothpaste, and floss. After passing out the kits to kids in the local Boys and Girls Club after-school program, Nordhoff taught them the best ways to brush and floss their teeth.
We’re honoring Katelyn as our Nurse of the Week for her inspiring work as a community nursing student helping low-income families and their children receive the health care they need when dental care gets too easily overlooked.
Although the nurse licensure compact gives nurses and employers new workplace and staffing options, critics have concerns about the process for achieving those objectives. Chief among them is that individual nursing boards and legislative entities have been left out of the loop not only in formulating compact statutory language to fit state law, but also in other key administrative ways.
With decision makers residing elsewhere, Ohio nursing leaders complain that the compact skirts state regulations calling for anyone involved in legislative action regarding the state reside in the state. The pact’s current structure leaves Ohioans powerless to modify the pact’s language so that it addresses their state’s unique culture while honoring its sovereignty. That includes lacking the kind of transparency—e.g., complying with open meetings and records acts—required of all other legislation. “We want to make sure that if we join any compact, Ohio decision makers are at the table contributing to its content,” says Lori Chovanak, MN, APRN-BC, chief operating officer for the Ohio Nurses Association.
Even though critics cite the inability to craft or re-craft compact language as a non-starter, they also worry about other long-term effects on the professionals who have to ensure quality patient care. For instance, Minnesota’s nursing leaders aren’t pleased that lawmakers might have to modify existing state law to accommodate a pact they didn’t help create. Yet they’re equally concerned about the state licensing board’s powers, especially regarding licensing and tracking, being usurped overtime. “Knowing which nurses are working in the states and which requirements they’ve met is very important to patient safety,” says Laura Sayles, government affairs specialist for the Minnesota Nurses Association. “But it also matters that by joining the compact, our board’s giving up its rights to do it job.”
Not all nurses belong to unions, but for states that have strong collective bargaining sectors, there is the real fear, say critics, that the multi-state licensing compact could interfere with their efforts to either negotiate the best agreement or even deal with a potential strike. Even though there’s additional concern that a multi-state license compact just opens doors for a mass exit of talent from lower income states to greener pastures, supporters say such hasn’t been the case.
Sandra Evans, MAED, RN, executive director of the Idaho Board of Nursing, an original pact member, and chairwoman of Nurse Licensure Compact Administrators, suggests that in the 16 years since the original pact has been in play, there’s been no evidence that the agreement has interfered with existing labor laws, stymied a union’s ability to do what it needs to do in terms of collective bargaining or even facilitated a shift in manpower. “That might be more perception,” says Evans, “than reality.”
That doesn’t mean, however, that nurse leaders aren’t apprehensive. Although patient safety is its ultimate objective, Sayles admits that as a union, MNA also must focus on the compact’s potential effect on labor issues. “Anything that allows employers to move nurses in and out without our knowledge of that movement,” she says, “is going to be of concern to us.”
According to William J. Pape’s 1918 book “History of Waterbury and Naugatuck Valley, Connecticut,” the City of Waterbury inaugurated the medical inspection of pupils by school nurses in 1904, making them an early adopter of the school nursing revolution. By 1913, the Medical Inspector of Schools had designated a central room to be used as a clinic for the nurses to examine and treat students.
A 1919 City of Waterbury Health Department Report cited that the school was using 5 school nurses to examine each child for contagious and infectious diseases. Infections were given prompt treatments when necessary, and followed up on by the school nurses to accomplish better health and sanitation for students. The 1920s and 30s brought in new standards to differentiate between medical care and school nurses, designating school nurses to tend to first aid, health screenings, and disease prevention. By that time, the Waterbury School Nurses had already pioneered the practice of school nursing, contributing greatly to the health and wellbeing of the city’s school children.
Today, school nursing is considered a specialty that requires advanced education and professional emergency care experience. School nurses promote health and safety practices, providing interventions to actual and potential health problems including acute injuries and managing chronic conditions like food allergies and asthma. For 112 years, Waterbury School Nurses have pioneered and specialized the practice of school of nursing, treating over two million pupils in that time. You can learn more about the School Nurses of Waterbury in their full report here.