This week we’re featuring Resisting the Slow Undoing of Human Rights, a Nursing Knowledge Activities column from the journal Research and Theory for Nursing Practice. Author Debra R. Hanna, PhD, RN, ACNS-BC, provided some insight as to how she prepared this column to write about the Transcultural Nursing Society. Read more below:
The column about Nursing Knowledge Activities, is intended to inform readers about events and developments in nursing knowledge. Having had a long-term interest in theory and research I wrote a series of columns to showcase different professional organizations dedicated to nursing theory activities.
Usually I write the Nursing Knowledge Activities column about 4-6 months before it appears in print. In October 2017 I began writing the May 2018 column. Having already written about several nursing theory organizations, I wanted to write about the Transcultural Nursing Society started by Madeleine Leininger. That Fall, I was doing background reading about twentieth century American history for a book I am currently writing. Each evening, the national news mentioned Congress wanting to overturn the Affordable Care Act. Also, there were news stories about refugees fleeing crisis situations from several parts of the world. Our politicians seemed divided about wanting to help refugees. That news broke my heart since it seemed that some politicians were not interested in helping humanity.
My first column for May 2018 was focused on a different topic. But then things came together on December 12, 2017. I decided to write a completely different column for May 2018. That morning I had read President Kennedy’s speech during my background reading. It reminded me of Leininger’s approach to human beings that was so nurturing, caring, and respectful of human dignity. The stark contrast between Kennedy’s approach to humanity and current political conversations, created a clear insight. I then examined the Transcultural Nursing Society’s website equipped with that insight. Once I saw the rich treasures that the Transcultural Nursing Society has to offer nurses today, I scrapped my other column. Within a half hour I wrote May’s column from beginning to end.
You can ready Dr. Hanna’s column, Resisting the Slow Undoing of Human Rights, here. To subscribe to Research and Theory for Nursing Practice, click here.
Chamberlain University College of Nursing students recently completed a two-week trip to Kenya as part of the Global Health Education Program. The program, which has been in existence for 23 years, provides Chamberlain nursing students the opportunity to put their nursing skills and education to use in different countries, like Haiti, Kenya, Brazil, and India.
Third year nursing student Christopher Monzon chose to travel to Kenya for his GHEP trip earlier this fall, working alongside local nurses and nursing students in five cities: Mukuru, Koch, Babadongo, Kamahuha, and Maasai Mara. The nursing groups helped provide healthcare and assistance in a variety of ways, treating around 400 patients per day. “Maasai Mara, located near the Tanzania and Kenya border, had a high number of patients with malaria so they needed anti-malarial medications and disease education,” Monzon said. “However, the tribe did not believe in vaccinations so we used a special plant called Artemisia annua to treat the patients. We also taught this tribe how to search for clean water, another serious issue in the region.”
Chamberlain’s Global Health Education Program partners with different organizations in each country, such as Family Hope Charity in Kenya and Hope for Hansan’s in India. Dr. Susan Fletcher, chair of the GHEP, works with her faculty to ensure that even with varying healthcare needs, every community is helped. Dr. Fletcher told DailyNurse.com: “The program’s focus across the board is health promotion and disease prevention with an emphasis on sustainability.”
Monzon and other students were partnered each day with translators and Thika medical students to diagnose patients, distribute treatment and medication, or travel to homes of bed-ridden patients. Because the students treated so many patients each day with limited time, they sharpened and honed their interview skills to figure out symptoms and appropriate treatments. But each team learned many valuable skills from working closely together. “For example, a Thika medical student taught me how to diagnose Rickets, a disease I had never encountered prior to the trip,” Monzon told DailyNurse.com. “Then I was able to teach the Thika students how to properly take a patient’s vital signs which they then took over for us while we were interviewing patients in clinics.”
These GHEP trips fill the Chamberlain College of Nursing requirement for the campus-based community health course, while providing students the opportunity to broaden their education outside of the United States. Program requirements include a 3.0 GPA, faculty recommendation letters, and an application with the campus president’s signature. Chamberlain also provides 10-12 scholarships annually for students requiring financial aid for these trips.
These trips are invaluable for Chamberlain students, as they not only practice their nursing skills and gain new healthcare skills, but get to treat patients from very different backgrounds. “Before leaving for Kenya, I wanted to be a travel nurse,” Monzon said. “Now I want to be an international nurse to help more people like those I met in Kenya.”
To learn more about the Chamberlain University Global Health Education Program, click here.
Concordia University Texas School of Nursing students are now utilizing a medical van to better serve their community. Their mobile Medical Missions Van operates as a pop-up clinic that provides free, basic healthcare to two counties and has plenty of space for medical supply storage and seating for clients and nurses.
Students first put the van to use last month to help individuals living under an Austin bridge, setting up foot-washing stations while a local ministry provided fellowship and food. Though these community healthcare activities are strongly helped by the use of the mobile medical clinic, nursing students have been working on projects like these since 2015, as part of their requirement for their Community Health course.
Concordia’s Nursing program director Dr. Greta Degen, RN, told CTX Blog: “The biggest impact the van has is that it allows Concordia nursing students to become the first stop for people in the community who are wrestling with a medical issue. Students can use their nursing knowledge to screen and educate individuals on their health issue or medication before needing to go see a doctor or visit an emergency room.”
Mobile medical clinics like this are used globally, especially in areas devastated by war, natural disasters, and humanitarian crises. The clinics provide a way for healthcare professionals to get medical treatments and supplies to people cut off or isolated from communities, and are especially helpful in areas lacking in public transportation.
To learn more about Concordia University Texas School of Nursing and their mobile Medical Missions Van, visit CTX Blog.
Andrew J. Johnson, APRN, CRNA, grew up in a rural area and always knew that it was the exact type of setting where he wanted to work. As the sole anesthesia provider for a critical access hospital in Olivia, Minnesota, Johnson loves what he does. But he does face quite a lot of challenges.
He took some time to tell us about his work. What follows is an edited version of our interview.
What kind of work do you do?
I am the sole anesthesia provider for our critical access hospital. I opened a pain clinic at our facility because access to care for those suffering with chronic pain was lacking. Fortunately, I was able to find an incredible mentor, Keith Barnhill, to teach me chronic pain management. I was then accepted into the post master’s advanced pain certificate program through Hamline University. The pain clinic has definitely benefitted our community.
I also provide anesthesia for obstetrics, emergency room, and surgical cases including general, podiatry, gynecological, ENT, orthopedics, and urology. In 2017, we became the first critical access hospital in Minnesota to get a Da Vinci surgical robot. This has definitely increased the number and complexity of general surgical cases we are able to do at our facility. We have been performing total hip and knee replacements the last 2 years, which was a much-needed service in our community.
Working in a rural area is quite different from what most nurses do. Have you worked in a more urban or suburban area before this? If so, how does working in a rural area differ from those places? If the facility you work in large or small?
Rural anesthesia is much different from that in urban and suburban facilities. Although the anesthesia doesn’t change, the number of resources available to trouble shoot and help in difficult situations is severely limited. I have always found that the toughest decision I make is what cases I shouldn’t perform at my facility.
What kinds of patients do you tend to see? How are they different from those you saw in a more urban setting?
I feel like the patients and staff have closer relationships in small communities. We all know each other, and many times are related to each other. I hear weekly from patients that they feel so comfortable knowing I will be doing their anesthesia because of our relationships in the community.
What have you learned from working as a nurse in a rural area?
There are many individuals and organizations that want to limit scope of practice for advanced practice nurses, especially nurse anesthetists, and thereby limit access to care for rural comminutes. It is easy to get busy with work and family and lose track of the politics of anesthesia, but it is vitally important to stay vigilant about what is going on in the medical and political arena.
Because it’s a rural setting, do you tend to know more of the patients or their families, as in a small-town? Do you get a lot of patients who have to travel a long way to get to you? How many miles might some patients travel? Are people ever helicoptered in? Brought by ambulance? How far?
I know most of the patients that I see for anesthesia and pain injections. In a town with a population of about 2,500, it is no surprise to run into people I have seen in the community. Most patients do not need to travel more than 45 miles to see us. There are about six hospitals in a 45-mile radius of Olivia. Some of these facilities provide a higher level of care, so we are able to transport to these facilities if we are unable to provide the level of care needed. For bad traumas, often the flight crews will land at the scene of the accident and evacuate the patient from the scene instead of delaying high-level care by coming through our emergency room. Certainly, there are times when these patients need to come to our emergency room for stabilization prior to transport.
What are the biggest challenges of working in a rural setting?
Call is always tough in rural settings. If can be tough to achieve a work/life balance because of the need to be available and within call range of the hospital. Because of this, my family has several hobbies that we can do together on our acreage including gardening, yard work, blacksmithing, exercising, hunting, and sports.
What are the greatest rewards?
It’s fun to be recognized in the community by patients that have been through the surgery department or pain clinic. They are appreciative of being able to be cared for in their hometown where they have friends and family to help with their recovery. I feel that community recognition makes it easier for my family to accept me not being home. My wife and kids can become frustrated with me getting called to work, but when they find out later I was helping one of their friends, they understand the importance of my job and are happy that I do what I do.
What would you say to someone considering moving to work in a rural area? What do they need to be willing to do or deal with?
Deciding to work in a rural facility is not a decision that can be made lightly. It is not just a job, but a lifestyle. My family has to take two vehicles to the movies, dinner, church, etc. Calling in sick to work is not an option. There is no additional help when emergencies arise.
Personally, I think there is no better place to raise a family that in a rural community, but I may be a little biased. To work in the setting, confidence is an absolute requirement. Someone will always try to challenge your decisions. As long as you can always make decisions with the patient’s best interest in mind, you will have the respect of your medical staff, and this will make for a satisfying career.
Also, you can’t decide not to see particular patients because there are no other options. As an example, I had to do the anesthesia for my wife’s caesarian section. I had someone hired to do her case, but her water broke a week before her schedule C-section. Another example of an interesting rural experience is when the locum I had hired to do my colonoscopy got the schedule confused and didn’t show up for the day. I had to do anesthesia for 6 procedures and was finally able to get someone to do my anesthesia in the afternoon.
In March 2016, Sutter Health and WellSpace Health started The Street Nurse Program. Funded by Sutter Health, the program is geared to meet the needs of an underserved population—those affected by homelessness—in Sacramento, California. To date, it has helped more than 200 people who have received access to on-site care, medical advice, disease management education, and wound care.
Amanda Buccina, RN, BSN, is the program’s sole nurse. While they are looking to expand the program, Buccina is making a huge difference in the meantime on her own. “I’m happy to be selected as the first nurse in this role. I was previously in a position managing Medicaid case management programs for a large managed care corporation,” explains Buccina. “When I saw the street nurse job description, it sounded like a great opportunity and one that aligned with my experiences. For the first time in a long time, I felt excited and inspired by a nursing role, so I knew that it was the right opportunity to pursue.”
According to Sutter Health, The Street Nurse Program provides a vital piece in the continuum of care, with programs and partners seamlessly working together to provide a whole health stability model for the most vulnerable among us.
“The Street Nurse Program is an effort to provide an access point into a traditionally very guarded population, enabling us to start linking the homeless to the services they desperately need,” says Buccina.
Oftentimes, those affected by homelessness won’t come to clinics. As Buccina says, “Working with this population, you have to be willing to meet people where they are.”
A great deal of her job involves building relationships. “I work to build trust and rapport with my clients so even if they don’t need me in that exact moment, we have a relationship and familiarity with one another. This comes in [handy] when clients do want and need support, like medical advice, an advocate at a doctor’s appointment, help getting into an alcohol or drug rehab program, or just general wound care,” explains Buccina. “Sometimes, honestly, they just want someone to listen to them–that there is somebody who is consistent and that they trust. If they know someone is invested in them, it makes it slightly more likely they will be invested in themselves.”
Buccina finds it touching when her clients let her into their lives. “They don’t have to let me into their world at all—and they do. It’s kind of like a window into their world. And if they trust me enough to help them,” she says, “it’s kind of a big deal.”
The University of Wisconsin-Madison (UW-Madison) has a rural health care immersion program where the focus of the curriculum is on disaster and crisis response. Their classroom discussions are usually hypothetical, but after a tornado hit northwestern Wisconsin in late May, nursing students in the rural health care program put their knowledge to the test by aiding in tornado relief efforts.
Clinical assistant professor Pamela Guthman was leading a team of seven nursing students in the Community and Public Health Immersion Clinical program in northwestern Wisconsin when a tornado hit nearby. Students were there to learn about the necessity of health care providers and health educators in rural and underserved communities.
The nursing students partnered with the American Red Cross to aid in recovery efforts, specifically those who were displaced after the tornado destroyed a trailer park. The students did not provide immediate medical attention, but they were able to help by interviewing people affected by the tornado, and providing those people with health and housing information. Guthman tells the Wisconsin State Journal,
“What we’re going to be doing is helping people who have been devastated by the loss of their homes. We know that housing is very closely related to a person’s mental health.”
The counties affected by the tornado have been under-resourced for a long time, creating a health disparity and lack of resources which makes it even harder for these communities to bounce back following a natural disaster. One of the goals of the rural health care immersion program is for students to learn a sensitivity for the challenges of rural communities. There is a need for both health care professionals working on acute crises and professionals focusing on prevention. Public health nurses are an essential part of the healthcare team in rural areas.
To learn more about the rural health care immersion program at UW-Madison and their service providing tornado relief aid, visit here.