Transcript Health Promotion in a Mennonite Community

Engaging Students in Community
Partnerships Equals Plain Learning
M. Susan Jones, PhD, RN, CNE, ANEF
M. Eve Main, DNP, APRN
Dawn Garrett-Wright, PhD, RN, CNE
Western Kentucky University
Objectives
• Discuss the process of accessing and sustaining
a relationship with an Old Order Mennonite
community designed to foster student
engagement.
• Discuss the challenges and outcomes of creating
an educational collaborative partnership with a
culturally diverse community.
• Describe the mutual benefit of a service
learning project for all members of the
partnership.
Mennonite History
• Anabaptists organized in 1500’s
– Baptism upon confession of faith (adulthood)
– Total separation of church and state
• Mennonites, Amish, Hutterites
• Allen County community one of three Old
Order groups
– Plain people
Beliefs and Values
• Simple life will bring them closer to God
• Patriarchal with men head of church and
family
• Strong sense of community
• Value honesty,
simplicity, humility
• Do not bear arms
Community Assessment
• Housing: simple wooden structures, no BRs,
large wood stoves, good repair
• Transportation: horse drawn buggies or buses
for long distances
• Dress: simple, plain, hand made
• Education: three schools, 8th grade, classes
taught in English and German
• Occupations: Diverse agricultural production
plus additional trades
Community Assessment (cont.)
• No police or fire protection
• Have community store, markets with
wide selection of products
• Leisure activities: reading, writing,
letters & conversation
• Socialization
– Church services/visiting
– Birthday calendar
Health Practices
• Do not seek health care until very ill or it
influences their ability to work
• Lack of health insurance
• Preference for natural remedies
• Home deliveries
• Care for elderly
• Limited immunizations
Accessing, Developing and Sustaining a
Relationship
• Use of insider
• Cultural desire
• Trust and respect are
essential ingredients
• Mutual exchange of
information
• Participatory model
• Cultural sensitivity
The Beginning: Challenges and
Outcomes
Diverse
Projects 19952001
• Poster on buggy safety
• Paper on the Evolution of Health Beliefs
• Cancer Brochure, multiple field trips
• Honor thesis on Maple Syrup Urine Disease
Health Promotion Days
(2001-2012) : Objectives
• Explore the health beliefs, values and practice
of an old order Mennonite group
• Demonstrate cultural sensitivity when
providing health education and care
(medical/nursing) to members of an old order
Mennonite population
• Provide opportunities for health care providers
to gain insight into their own
prejudices/beliefs/attitudes that influence their
practice
Health Promotion Days: Key
Players
• Director of South Central KY AHEC
• Faculty
– University of Louisville, School of Medicine
• Family Practice Medical Residents
– Western KY University, Department of
Nursing
• BSN/MSN Nursing Students
• Members of the Mennonite Community
Health Promotion Days: Monthly
Procedure
• Nursing faculty visit at least one week prior to
clinic day to determine class topic
• Educational topic selected by members of
community
• Nursing students/residents rotate preparing
and presenting teaching session
• Medical staff (resident and physicians) see
patients following educational program while
nursing students conduct health screening
(glucose, cholesterol, BP)
Examples of Educational
Topics
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Depression/ Mental Illness
CPR/First Aid Classes
Suturing
Care of Special Children/Elderly
Use of Herbs/Vitamins
Immunizations
Women’s Health Issues
Developmental Milestones
Eye Disorders
Preventive Care
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Blood pressure screening
Glucose screening
Lipid screening
Bone density screening
Dental care
Immunizations
Additional Projects and Studies
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Accuracy of Portable Lipid Analyzer Study
Colorectal Cancer Screening Project
Burn study: B & W and Leaf Therapy
Obesity Study
Well Child Screening
Hearing Screenings
Nursing Students Integrated in
Diverse Ways
• 3 credit hour elective course
• Field trips as part of community health
nursing and interdisciplinary rural health
course
• Participation in data collection with
research studies
• Engaged in health promotion projects
Challenges
• Establishing and maintaining the
relationship requires much time
• Maintaining cultural appropriateness
• Avoidance of technology
• Cost
• Participatory model
Benefits: Community/Faculty
• Community members
– Use of participatory model
– Improved health care
• Faculty
– Networks formed between the community
and the universities
– Research opportunities
Benefits: Students
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Opportunities to practice cultural sensitivity
Increased skill in teaching
Perfected psychomotor skills
Engaged in community based research
Use of participatory model when promoting
the health of this population
Student Evaluations
• How do you think the culture of the Mennonite
community impacts their health?
Health is looked at as ability to do work, similar to most
rural communities.
…it encourages them to be more healthy because they
know it is much more difficult if they have to seek care
from the outside.
…they delay embracing some of the new health promoting
behaviors...immunizations, dental care.
Student Evaluations (cont.)
• Did your experience with the Mennonite project
enhance your understanding of providing health care
in a culturally appropriate context?
…providing health care is not just about meeting physical
needs but also cultural needs of the group being served.
…it helped me understand that while the information
provided might be the same, the way it is provided can
make the difference.
You must respect a culture’s beliefs and you cannot simply
go in and expect them to accept what you offer.
My experience… helped me to look at ways in which I
learned in my everyday practice.
Student Evaluations (cont.)
• Discuss the differences and similarities between the
clients you provide nursing care for and the patients
in the Mennonite community.
The difference in the patients is…that I found the Mennonites
to be anxious to learn and wanted information about their
health.
The clients in my daily practice seem to expect care and
seem more demanding and less appreciative of the care
they receive.
The diseases are the same. Mennonite members had a quest
for knowledge about all the processes and diseases.
I felt like the Mennonite community showed more interest in
preventive care than many of the patients I encounter.
Student Journal
I am trying to be more culturally aware, not just of this
culture, but all the many cultures I come in contact with. It
has really made me take a hard look at myself and examine
my own stereotypes and prejudices. I realize I have too
many and that is something I am working on changing. It
was something I really wasn’t even aware of but this
experience has really opened my eyes.
References
Armer, J. M. & Radina, M. E. (2006). Definition of health and health promotion behaviors among Midwestern
old order Amish families. The Journal of Multicultural Nursing & Health 12 (3), 44-53.
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innovative intervention strategies. Journal of Agricultural Safety and Health 8 (1), 67-81.
Katz, M.L., Ferdetich, A.K., Paskett, E. D., Harley, A., Reiter, P.L., Lemishow, S., Westman, J. A., Clinton,
S.K. & Bloomfield, C. D. ( 2010). Cancer screening practices among Amish and non-Amish adults living
in Ohio Appalachia. The Journal of Rural Health 27 (2011), 302-309.
Main, M. E., Jones, M. S. & Abell, C. (2011). The accuracy of referral for portable lipid analyzers in an old
order Mennonite population. Online Journal of Rural Nursing and Health Care, 10 (2), 55-64.
Main, M.E., Williams, D.H. & Jones, M.S. (February, 2012)). Treatment of burns with burns and wounds (B &
W) ointment and leaf therapy. Journal of Alternative and Complementary Medicine 18 (2), 109-111.
Reiling, D.M. (2002). Boundary maintenance as a barrier to mental health help-seeking for depression among
the old order Amish. The Journal of Rural Health 18 (3), 428-436.
Rieman, M.T., Hunley, Woeste, L. & Kagan, R. ( September-October 2008). Is there an increased risk to
burns to Amish children. Journal of Burn Care and Research 29 (5), 742-749.
Rhodes, D. A, & Hupcey, J. E. (2000). The perception of farm safety and prevention issues among the old
order Amish in Lancaster County, Pennsylvania. Journal of Agricultural Safety and Health 6 (3), 203-213.
Questions?