Immersion Experience #3 Cultural Assessment Saint Petersburg College Introduction Nurses act as patient/client or “consumer” advocates. To do so, a nurse must at a minimum, listen; to do so well a nurse must do more than listen, a nurse must truly understand. When the client is of a different culture or ethnicity this becomes a challenge, as culturally appropriate or competent care is necessary and there are many differences between cultures. One way to enhance cultural competency is through immersion. Immersion can increase awareness of personal beliefs, values, behaviors, and learning from clients (Maltby, & Abrams, 2009).
In this assignment we were to immerse ourselves in the culture we have been studying by spending six or more hours observing group cultural interactions. The purpose was to then synthesize the learning from this experience with that of Immersion Experience One and Two, thereby increasing our awareness and ability to provide culturally competent care. Description of Group Experiences The subculture I chose to learn about through these immersion experiences is homeless people. I enjoyed two separate experiences in which I had the opportunity to observe, interact and learn from this subculture.
The first experience was at Beacon House, preparing and serving a meal to low income and homeless people, and the second was at the St. Petersburg Free Clinic Health Center which functions as an urgent care clinic for adults aged? 18–64, many of whom are homeless. Beacon House Beacon House is a temporary and transitional shelter offering 30 beds to single, homeless men. Per Yolanda Giovannetti, the Director of Beacon House, they served over 35,000 free meals in 2010 and provided over 9,500 nights of shelter to homeless men.
Beacon House also functions as a community kitchen, where free dinner is served six nights a week to people in the community that are hungry. You do not have to be staying at Beacon House to receive a free meal — you just have to be hungry. I assisted in cooking and serving a dinner on a Monday night. The eating area is clean and bright with separate tables covered in colorful tablecloths. Simple chairs are provided, though I noticed some people chose to eat standing up. The kitchen is stocked with adequate food, cooking supplies, serving dishes and cleaning supplies, the majority of which has been donated.
The labor to prepare, serve and clean up afterwards is provided by clients of Beacon House, individual volunteers and volunteer groups. The evening I assisted there was a group of volunteers from the Unitarian Universalist (U. U. ) Church. They come once a week to Beacon House to provide meals and are very involved in the other services provided there (providing clothes, personal hygiene items, etc. ). I arrived at 3pm to start preparing the meal. By 4pm there was about 15 people lined up outside for dinner.
We served dinner at 5pm to everyone that showed up, about 45 people. The meal consisted of spaghetti and meatballs a salad, cookies, bananas, and coffee, milk or water. During this experience I noticed the majority of the people being served were homeless Caucasian, middle-aged men, slim or underweight; many claimed they were veterans. There was about 15 or so African American men that came in for dinner as well and most of them were also homeless and many claimed they were veterans. I did notice that the two different ethnic groups did not sit together during the meal.
I am not sure if this was prejudice or merely preference as many of the men seemed to know each other and appeared friendly. There was no arguments or violence and no overt intoxication or behavior indicative of drug use. I tried to interact with the people being served as much as possible and found that some were very open and some preferred not to interact or even make eye contact. Ethnicity and language did not appear to be a barrier for our interactions, and although some chose not to participate in any interactions, no one was rude or aggressive toward me.
St. Petersburg Free Clinic Health Center The gentleman I interviewed for my Immersion Experience #2 paper is a client of the Free Clinic Health Center and highly recommended I visit it for more experience. I have often wanted to volunteer at the St. Petersburg Free Clinic, but never seemed to have the time or opportunity, so spending the morning there was a real privilege of which I could probably write an entire separate paper! The Free Clinic Health Center provides care to adults aged? 8–64 without private insurance, Medicare, Medicaid, and who do not qualify by low income for county health care—in other words those that might normally “fall through the cracks”. Professional doctors and nurses volunteer their time and patients are? assisted with medications for the short term at little or no cost. On a long-term basis, patients who qualify are assisted with obtaining? medications through the pharmaceutical Drug Assistance Program (DAP). I was not really sure what to expect during my visit and was very lucky to be teamed up with Dr.
William Moore. We saw a dozen or so clients from 8:30 am to about 1 pm. The clients all had appointments and were seen for free, though there is a walk in clinic where care is given on a first come first serve basis. There is a suggested donation of five dollars, however I was not aware of anyone paying. I was surprised that almost half of the clients were either completely homeless, or in transitional housing. We saw two Vietnamese patients who had a language barrier, but were accompanied by younger relatives that were able to translate for them.
Three quarters of the clients we saw were diabetic and African American. Dr. Moore noted that a large amount of his clients at the clinic are African American or homeless Caucasian men with diabetes and cardiovascular and/or renal diseases. The Free Clinic Health Center does not treat sexually transmitted diseases, pain issues, manage clients with complex medical conditions such as HIV, or provide Obstetric and Gynecologic services, therefore some of these clients are referred to other specialists.
Dr. Moore treated each client with respect and appeared to have an excellent relationship with the clients; he had an easygoing way about him that seemed to put everyone at ease. Because of this the majority of the clients were happy to interact with me and seemed to give me their trust immediately. We discusses their cultural practices, religious foundations, health related beliefs and behaviors and frustrations many had with governmental agencies and public healthcare systems.
It was apparent that none of the clients were rich, few were employed and that many had additional problems such as inadequate nutrition and housing. Though many of these people might qualify for Medicaid, I found out that Medicaid is not that easy to qualify for, access or maintain. Overall, it was a very interesting and fulfilling day in which the client’s needs came first and foremost. Comparison to Cultural Research Performing the cultural research for Immersion Experience One prepared me very well for my experiences at Beacon House and the Free Clinic Health Center.
Spending time at these centers gave me an opportunity to interact with a large amount of homeless and disadvantaged people. Of those willing to interact some agreed to discuss their cultural practices and religious beliefs. I found them to be very varied in both cultural and religious beliefs. Many of the homeless carried some of their traditional “ethnic” or cultural beliefs such as African American Folk Medicine and superstitious beliefs regarding cancer. For example, one African American woman stated that she “needed to get back to Georgia to eat some clay”.
She believes eating the red clay in Georgia keeps her digestion healthy and gives her energy. She also believes that lemon juice and apple cider vinegar will control her hypertension. Another homeless gentleman said he had “cancer of the stomach”. When asked if he had seen a physician he stated that yes, he had, but that the “doctors want to do surgery and everyone knows that will spread the cancer”. When I asked others about health care and health related beliefs many said they do not go to a “regular doctor unless it’s really serious or an emergency”.
They said that the most common medical care they utilize is either the Free Clinic Health Center or the Emergency Room. The most common reasons they gave for this were financial barriers, transportation and fear of being judged regarding their life choices and substance abuse. While some had received Medicaid in the past they failed to be able to maintain it as they do not have steady housing or even proper identification. Some said that even if they do go to a doctor they can’t usually afford the medicine, and that is why they use the Free Clinic.
Many said they were veterans but few utilized the Veterans Administration Health services as they felt they “weren’t welcome” due to substance abuse issues, dishonorable discharges or they did not “trust the government”. Most of what I witnessed during this experience was consistent with the cultural research performed for Immersion Experience #1. The majority of the homeless served at Beacon House were middle-aged men, slim or underweight (Centers for Disease Control and Prevention, 2010; Homeless Management Information Systems, 2009).
The cultural and religious beliefs of those at Beacon House and the Health Center were varied with some use of Folk Medicine and superstitious beliefs (Lin, 2007). Many of them described an external locus of control (Murphy, 2007; Rhoades, et al. , 2011; Williams & Stickley, 2011 & Zlotnick & Zerger, 2009), suffer from cardiovascular disease, diabetes and substance abuse (Baggett, O’Connell, Singer & Rigotti, 2010; Eyrich-Garg, Cacciola, Carise, McLellan, & Lynch, 2008, Lee et al. , 2005), underutilize health care (Bharel et al. 2011; Eyrich-Garg, 2008), and report that the most common barriers to health care were finances, transportation, fear of being judged or stigmatized and mistrust of government and authority figures (Eyrich-Garg,2008; Hwang & Bugeja, 2000). Comparison to Cultural Assessment When comparing what I learned on my third immersion experience to my second experience with J. B. , I appreciate even more so J. B. ’s individuality. J. B. did not ascribe to any particular cultural, ethnic religious or folk practices.
This made him different from many of the people I met on my group experience and different from the research which indicated the common use of Folk Medicine and superstitious beliefs (Lin, 2007). J. B. took total responsibility for his life and his healthcare, having a very strong internal locus of control, which was also very different from most of the people I met during this third immersion experience and the research (Murphy, 2007; Rhoades, et al. , 2011; Williams & Stickley, 2011 & Zlotnick & Zerger, 2009).
The things he did have in common with those I met were his demographics, in that he was an older Caucasian male and a Vietnam Veteran, which is common among the homeless and that he had hypertension, diabetes and a history of substance abuse–which were also common in the people I met at Beacon House and the Free Clinic and in the research (Baggett et al. , 2010; Eyrich-Garg et al. , 2008). Implications for Health and Healthcare During this final experience it became very clear to me that “the system” may be a large part of the problem for the homeless.
For example, many of the healthcare issues faced by the homeless are related to diet. Food provided to the homeless in shelters is high in fat, carbohydrates and salt. This diet may cause or at least contribute to cardiovascular disease and diabetes (Hunger and Homelessness Survey, 2010). Providing healthier food, education regarding diet and health and kitchens for the homeless to prepare foods themselves would help reduce this barrier to health. Substance abuse is another large issue among the homeless (Eyrich-Garg et al. , 2008).
It is very difficult to get or to keep shelter or transitional housing if a person is currently abusing drugs or alcohol. This becomes a large barrier and some cities are beginning to understand that people with substance abuse problems cannot be rehabilitated if they do not have a safe place to live (Bharel et al. , 2011; Eyrich et al. ), giving this shelter first could remove this barrier. Another example is computerization. While computerization is necessary, it becomes a barrier to those who have literacy issues or to those that have lived “off the grid” and do not have personal identification (Bagget et al. 2010; Bharel et al. , 2011). Improving literacy and incorporating basic computer training to clients could reduce this barrier. Implications for Nursing Care to Improve Care and Remove Barriers I believe that a lot of the things I experienced can change, but it will take a concerted and global effort to change them. Of course, starting where you are is always the best way, and as a nurse I feel there is a lot nursing can do to help the homeless get adequate healthcare.
In addressing the needs that I witnessed at the Health Center for the Free Clinic, one of the first things I would do is start a mobile unit to treat the very large diabetic population in St. Petersburg. Transportation is a barrier for many of the people, and timely foot care and wound care could then be brought to the clients. I also think that making diabetic education mobile would increase both individual and group participation. While the Free Clinic does offer free diabetes education in weekly in the evenings I am told that it is not well attended due mostly to transportation issues.
As many of the healthcare issues I saw were related to diet; food should improve health, not be a barrier to it. I would like to adapt a system similar to one used in the inner city in Denver. Fresh fruits and vegetables are available to the economically disadvantaged and homeless there through a really interesting community gardening system. Anyone in the city can sign up to participate in the community garden system. The gardens are set up by volunteers (some who stay in the homeless shelters, rehab programs, and transitional housing) in front of the houses and apartments on the sidewalks.
Each garden is small, maybe 10 ft x 10 ft. , and once a week the volunteers come around, tend the gardens and pick the fruits and vegetables that the residents have not used and are ripe. These then go into a “community pile” and are distributed among the shelters and food banks. Lastly, I believe that literacy may be one of the biggest barriers affecting the healthcare of many people, including the homeless. As nurses we can at the very least identify literacy issues, and refer clients to services to help with literacy.
This means we must take the time to really notice if the client is able to read the forms etc. that we put in front of them, instead of rushing to get everything signed and moving the clients on to the next step when they may still not understand the first step. If we are able to affect literacy we will better be able to utilize electronic records that our clients can also use. Recently I was in Chicago at Northwest and all of my personal medical appointments, records and forms were accessed by me directly through my computer.
This was wonderful for me, however I can see that for many people with literacy issues this would be a real barrier. Conclusion It is apparent from the three immersion experiences that the homeless population is made up of many different individuals and is a diverse group. To meet the needs of this group or subculture nurses need to increase their awareness of the personal beliefs, values, and behaviors, of the homeless as well as their awareness of their own. Once we truly open ourselves to this we can begin to learn from our clients, and they in turn will trust in us and begin to learn from us.
References Baggett, T. , O’Connell, J. , Singer, D. , & Rigotti, N. (2010). The unmet health care needs of homeless adults: a national study. American Journal of Public Health, 100(7), 1326-1333. doi:10. 2105/AJPH. 2009. 180109 Bharel M, Creaven B, Morris G, Robertshaw D, Uduhiri K, Valvassori P, Wismer B, Meinbresse M, Sergeant P (Ed. ). Health Care Delivery Strategies: Addressing Key Preventive Health Measures in Homeless Health Care Settings, 24 pages. Nashville: Health Care for the Homeless Clinicians’ Network, National Health Care for the Homeless Council, Inc. 2011. Centers for Disease Control and Prevention: National Prevention Information Network. (2010). The homeless. Retrieved from http://www. cdcnpin. org/scripts/population/homeless. asp Eyrich-Garg, K. M. , Cacciola, J. , Carise, D. , McLellan, A. T. , & Lynch, K. (2008). Individual characteristics among the literally homeless, marginally housed, and impoverished in a U. S. substance abuse treatment-seeking sample. Social Psychiatry & Psychiatric Epidemiology 43(10), 831-842. Retrieved from http://www. springerlink. om/content/k55j2h6656316mwl/ Homeless Management Information Systems (HMIS) 2009. U. S. Department of Housing and Urban Development, Retrieved from http://portal. hud. gov/hudportal/HUD? src=/program_offices/comm_planning/homeless/hmis Hunger and Homelessness Survey. ( 2010). A status report on hunger and homelessness in America’s cities: A 27 City Survey. Washington, DC: United States Conference of Mayors. Retrieved from http://www. ncceh. org/attachments/articles/461/USCM_2010_Hunger_Homelessness_Report. pdf Hwang, S. , & Bugeja, A. 2000). Barriers to appropriate diabetes management among homeless people in Toronto. Canadian Medical Association Journal, 163(2), 161-165. Retrieved from EBSCOhost. Lin, L. (2007). In Search of Home: From Home to Homeless to Housing. Perm J. 2007 Spring; 11(2): 70–73. Retrieved from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3057742/ | | | Lee, T. , Hanlon, J. , Ben-David, J. , Booth, G. , Cantor, W. Connelly, P. , & Hwang, S. (2005). Risk factors for cardiovascular disease in homeless adults. Circulation 111(20), 2629-2635. Maltby, H. , & Abrams, S. (2009). Seeing with new eyes: the meaning of an immersion experience in Bangladesh for undergraduate senior nursing students. International Journal Of Nursing Education Scholarship, 6(1), doi:10. 2202/1548-923X. 1858 Murphy, R. T. (2007). Enhancing combat veteran’s motivation to change post traumatic stress disorder symptoms and other problem behaviors. In Arkowitz, H. , Westra, H. Miller, W. , & Rollnick, S. (Eds. ) Motivational interviewing in the treatment of psychological problems, (pp. 57-84). New York, NY: Guildford Press Rhoades, H. , Wenzel, S. L. , Golinelli, D. , Tucker, J. S. , Kennedy D. P. , Green, H. D. & Zhou, A. (2011). The social context of homeless men’s substance use. Drug Alcohol Depend, 118(3): 320-325. Retrieved from EBSCOhost. Williams, S. , & Stickley, T. (2011) Stories from the streets: People’s experiences of homelessness. J Psychiatric Ment Health Nurs, 18(5): 432-439. Retrieved from EBSCOhost.