As families and friends gather for Thanksgiving Day this year, there will likely be oft-repeated tales about favorite recipes or the family stories that always make everyone laugh. In the midst of these gatherings is an excellent opportunity to learn more about what makes your family unique – in every sense of the word.
In 2004, the Surgeon General, through the Department of Health & Human Services, designated Thanksgiving as National Family History Day. This is an opportunity for all families to learn more about the common and rare diseases that can run through several generations.
As you all reminisce about holidays gone by, it’s a good time to begin documenting the various health conditions family members have. If you have high blood pressure and other relatives do too, it’s a great opportunity to educate the younger family members about the disease in an open, honest, and informed manner. The teens in the family don’t need to be terrified about the potential for heart disease or diabetes, but they should be armed with information about how they can help keep themselves healthy.
National Family History Day gives families a chance to uncover common threads they might not have realized. While the Surgeon General’s office found that most Americans believe in the important of knowing a family history, only about one-third have ever tried to document their own family’s health history.
What should you ask about? Really anything that might help you. Once you know the common threads, you can all learn about how to stay healthy or manage those specific conditions. For instance, are there relatives with breast and ovarian cancer (especially early onset) from generations ago? What about testicular cancer? When everyone is together, you can act as an educated group to make sure family members are getting appropriate testing or monitoring.
Because the Surgeon General considers family history as such an important health indicator and screening approach, the office has created the My Family Health Portrait online monitoring tool to help families document conditions and diseases. This tool means the documented history can be shared among family members and updated as health changes occur. Family members can even bring a copy of the document to healthcare visits to help inform their health team about important information.
Nurses don’t need anyone to tell them what kind of a predictor family history is. Each day, they see families with shared conditions. But if they don’t discuss their own detailed family health histories and if they don’t always ask the right questions, they could be missing some important health information of their own. Many families don’t talk about things like reproductive health problems or of mental health issues. Some might not discuss alcoholism or addiction. But each of these health conditions provides an essential piece of a family’s health picture.
Before you begin this process, the Surgeon General’s office has prepared some tips to help you. You’ll want to be ready to get the information, but realize you might not get everything on the first try. Make sure you are clear about what you are doing and why. Some people don’t like to talk about their health issues, but if they realize it could help save a loved one, they might look at your information gathering in a very different light.
Consider this an ongoing conversation among family members, and that Thanksgiving is just a start. Realize not everyone will be on board. Get as much information as you can without upsetting anyone. Be encouraged by what you can find out – you are helping your family now and for generations to come.
I had never received the backhanded compliment of “oh, she has such a pretty face” until recently. That was a compliment reserved for fat women. I did not consider myself fat at all. I would describe myself as overweight, but never fat. If I could still purchase clothing out of regular department stores, I did not believe myself to be obese. Even when I was hospitalized last year and the doctor’s notes said “…obese, 47yrs old female,” it did not truly register. However, once my vanity was attacked it hit home.
Sometimes, I see myself in the mirror and wonder how did it get to be this way. I am 5’4″. I weigh 210 lbs and am a Registered Nurse! Euphemisms like “thick,”” full-figured,” and ” healthy” only mask what I know to be the truth. This body that I live in is well on its way to diabetes and hypertension. Thankfully, in this moment I do not have any of those diseases, but it is just a matter of when, not if.
Being overweight has affected my self-esteem, my sense of self-worth, my self-love. It feels like a self-inflicted punishment. When I think back to when I was slim and feeling good, it almost brings me to tears. I start asking myself how did I let it get this out of hand? Why didn’t I just get up from the table? Stop eating at fast food restaurants? Continue to exercise? I am not a fat person who does not know how I got fat. I know exactly what I did, which I think makes it all the worse.
There are times I find it difficult to teach my patients about health and wellness. I wonder if they are looking at me and finding me a hypocrite. Or are they realizing that I, too, understand how hard it is to walk that path.
The heavier I became, the more crap I accepted from the men I dated. I no longer felt I that should be respected or loved entirely. Glad that they were in my life was enough. Trust me, when you do not love you, no one else does either. I stayed with a man who told me that he did not usually date “big girls.” So, I sat wondering, should I feel special that you chose me? I found myself always trying to overcompensate for not being thin, for not being his ideal of beauty. I was showing him that my love was not worth it because it did not come in a perfect size 4, 6, or 8. I was depleted walking out of that one.
So now at this juncture, I am ready to lose the weight. I mean do what is necessary to get to where I feel comfortable in my skin. This is not simply about my vanity, but about my life, my health, and self-love. So, I am inviting you on this journey with me. Come along.
If you’re one of those workers who never seems to take time off, this is your wake up call to put in for some real time off. If not for a whole week, then at least a chunk of time that gives you three or four days off in a row. Why is taking vacation time so important? Simply put, taking time off that’s given to you by your employer will make you a better worker and a happier person.
And, no, taking vacation days to get your mammogram done and your contact lenses renewed doesn’t count. Although we are almost all guilty of tossing away some vacation days to take care of personal business, vacation days are there for a reason.
Here are four top reasons to take your time.
You Need It
No one can work at a steady clip without a break and remain productive. No matter how much you love your job, doing it constantly can get to be a grind every now and then. Your body and your mind need time to do something else.
It’s Time for Fun
You may not be able to take a two-week vacation to paradise, but a couple of days off can work wonders. Sometimes a morning of catching up on a hobby followed by an afternoon of back-to-back movies and meeting up with friends for dinner is as close to paradise as you might get. It’s still worth it and if it’s all you can manage, take it. The point is to enjoy being away from work.
Your Health Depends on It
Yes, some people do spend vacations overindulging, but more often people on vacation get more sleep and also get more exercise. They eat foods they enjoy at a slower pace and often with people they want to be with. They usually take time to do what interests them, whether that’s a day-long hike or a day-long session with a stack of books. And a lot of vacation time finds people outside more then they are normally able to be. Can’t you just feel your blood pressure going down?
Your Creativity Needs a Boost
Shaking up your routine frees your brain to think in new ways. When your head isn’t full of all the daily details of your work, you have the time and energy to let new ideas float to the surface. Time off can actually boost your creativity and give you a new perspective.
You can probably think of a few more reasons. While you’re doing that, pick the days you want to take off and put in your request to work. You won’t regret it.
Knowing your rights and options—and even more important, how to advocate for them—can help you break through the barriers on your path to career success.
Nurse practitioner George Copeland, MSN, NP-C, NRCME, is at the top of his profession. He’s been a nurse for 25 years, has earned advanced degrees and certifications, has his own family practice in southeast Florida, and teaches part-time at a community college.
Yet achieving a successful nursing career wasn’t always easy for Copeland, who was diagnosed with bipolar disorder in 1981. Like many new RN graduates, he started off working in the traditional hospital setting. But he quickly realized that he couldn’t handle the constant pressure of shift work.
“I tried, but I cannot work in that setting,” he explains. “I can’t take that particular kind of stress. Stress is the number one trigger for people with bipolar disorder. That’s why I went back to school to become a nurse practitioner so that I could work at my own pace and at what I wanted to do.”
“The Stigma Is Real”
It’s impossible to make generalizations about nurses and nursing students who are living with mental health disabilities, because the term encompasses such a broad range of conditions—including bipolar disorder, schizophrenia, depression, post-traumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and more.
But this often-unrecognized population of minority nurses does have one thing in common. All too frequently, they face formidable barriers on the path to career success in nursing, from self-doubt and stigma to bias and outright discrimination in education, licensing, and employment. That’s in spite of the fact that the Americans with Disabilities Act (ADA) has been the law of the land since 1990 and will celebrate its 25th anniversary this year.
“Nurses with mental health challenges are struggling, and the stigma is real,” says Donna Maheady, EdD, ARNP, founder and president of ExceptionalNurse.com, an online resource network for nurses and students with disabilities. “Often they are very hesitant to ask for accommodations [under the ADA], or to come out in public as needing help, because of the fear of potential discrimination. They’re scared silent.”
Researcher Leslie Neal-Boylan, PhD, RN, CRRN, APRN, FNP-BC, dean of the University of Wisconsin Oshkosh College of Nursing and author of Nurses with Disabilities: Professional Issues and Job Retention, has documented ample evidence that disability-based discrimination is alive and well in the nursing profession.
“Many administrators don’t seem to understand that they’re really leaving themselves open to legal action,” she says. “The nurse develops a disability, or reveals it, and then the discrimination begins—the assumptions that these nurses can’t do the things they’re supposed to do, and that people will be uncomfortable around them.”
But even though a surprising number of nursing gatekeepers still seem to be clueless about their obligations under antidiscrimination laws, that doesn’t mean you have to be. If you’re a nurse or student with a mental health disability, your most effective success strategy is to actively be your own best advocate.
“It’s very important for nurses with any kind of disability to know their rights going in, rather than feeling vulnerable and being afraid to make waves,” says Karen McCulloh, BS, RN, co-founder and co-director of the National Organization of Nurses with Disabilities (NOND). “But not all of them do, and not all of them are good self-advocates.”
Do’s and Don’ts of Disclosure
Because chronic mental health conditions are “invisible disabilities,” your biggest self-advocacy decision is whether or not to disclose your disability to potential or current employers, says Robin Jones, MPA, COTA/L, ROH, project director and principal investigator for the University of Illinois at Chicago’s Great Lakes Disability and Business Technical Assistance Center and an instructor in the university’s Department on Disability and Human Development.
First, be aware of what the law says about your disclosure rights. According to the Boston University Center for Psychiatric Rehabilitation, a research and service organization dedicated to improving the lives of people with psychiatric disabilities, “Under the ADA, a person with a disability can choose to disclose at any time, and is not required to disclose at all unless s/he wants to request an accommodation or wants other protection under the law.”
The pros and cons of the decision to disclose must be weighed very carefully, because disclosure can be a double-edged sword. If you know that you’ll need the employer to provide accommodations that will help level the playing field for you, then you must disclose. But the unfortunate reality is that bringing your “hidden” disability out into the open may result in discrimination.
If you decide that the benefits outweigh the risks, then when, what, and how much should you disclose?
“The general consensus is to disclose as little as possible. Disclose only as much as you need to get the support you need,” Maheady advises. “If you’re talking with your co-workers, you don’t have to go into every detail of how long you’ve been in therapy and what meds you’re on. That kind of information should be shared only with the designated people in the organization whom you’d request accommodations from, such as the human resources or equal employment opportunity departments.”
It’s also important to know that you don’t necessarily have to make your disclosure immediately. “The whole issue of when to disclose is totally based on when you believe you need to ask for an accommodation,” says Jones. “You have no obligation to disclose until that time.”
Adds McCulloh, “Sometimes when you start a job, you don’t think you’re going to need an accommodation, but you may end up needing one after all. So if you need to disclose later, you can. I know that some employers are not pleased about that. But you do have the right to do that.”
Still, many experts recommend that it’s usually better to tell the employer up front. This not only establishes your legal rights from day one but also increases your chances for success by enabling you to receive accommodations right from the start. Furthermore, if you don’t disclose but later experience problems on the job as a result of your condition, such as a bad performance review, employers are less likely to be sympathetic—and the ADA may not protect you—if you suddenly pick that time to reveal that you have a psychiatric disability.
Early disclosure makes good sense for nursing students, too. “From my standpoint as an instructor, I would say the earlier the better, so that I can make accommodations for that student at my end,” says Patricia Giannelli, DNP, APRN, FNP-BC, PMHCNS-BC, ACNS-BC, assistant professor at Quinnipiac University School of Nursing in North Haven, Connecticut. “In our program, we always encourage students with disabilities to let us know as soon as possible, because we want them to succeed and to have all the tools they need.”
Know the Law(s)
Knowledge is power. That’s why another key self-advocacy strategy is to make sure you’re thoroughly knowledgeable about all the various disability rights laws that apply to you. You may find that you’re protected by more laws than you thought.
At the federal level, nurses who work at, or are applying for jobs at, private health care facilities with 15 or more employees are covered by Titles I and III of the ADA. If you’re a nursing student, or a nurse who works for a governmental or federally funded employer, such as a VA hospital, you’re covered under Title II of the ADA and Section 504 of the Rehabilitation Act of 1973.
Both laws protect people with disabilities from discrimination and entitle them to receive “reasonable accommodations” that will help ensure that they can perform the essential functions of the job or education program. For example, says Copeland, “When I was in nursing school, I had problems with not being able to concentrate. So I went to the Office of Students with Disabilities and asked for a quiet place to take exams, and extra time to take them. They gave that to me and they also gave me free counseling.”
Next, you need to be well-informed about what kinds of accommodation options you have the right to ask for. The federal Job Accommodation Network’s 2013 report, Accommodation and Compliance Series—Nurses with Disabilities, provides some examples of reasonable workplace adjustments a nurse with a mental health disability could request, including:
• Reduced distractions in the work environment, such as a quiet place to chart;
• Being able to take breaks or time off to see your therapist, talk to your therapist on the phone, or give yourself some downtime to relieve stress;
• More flexible scheduling, such as being able to work a shorter shift or one that’s less demanding and stressful;
• Modifications in the way you’re managed, such as having your supervisor provide to-do lists, written rather than verbal instructions (or vice versa), reminders about upcoming deadlines, and more frequent feedback about your performance.
In addition, the ADA Amendments Act of 2008 clarifies and expands the definition of “disability” in a way that’s especially beneficial for people living with chronic mental health conditions. The Amendments stipulate that “an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.”
In other words, Jones explains, “You don’t have to always be exhibiting the limitations of your mental health disability to be covered under the ADA. For example, a nurse may be doing fine without any accommodations but then suddenly starts having problems as a result of switching to a new medication. That’s an episodic situation in which the nurse would be entitled to receive a temporary, short-term accommodation.”
Federal protection for working nurses doesn’t end with the ADA. “Many nurses with disabilities don’t know that they can, for instance, take time off under the Family and Medical Leave Act if they need to leave work to go to a medical appointment [or if they need to be hospitalized],” Neal-Boylan says.
And don’t forget about state and local equal opportunity laws. “Many state laws provide greater protection for people with disabilities than the federal laws do,” Jones points out. “For example, if you live in California, you would be much better off pursuing an employment discrimination claim under your state’s civil rights laws than you would under the ADA. It’s just a stronger law.”
Should You File a Complaint?
Being fully aware of your rights as a nurse or student with a mental health disability also means understanding what action you can take if those rights are violated. In cases of obvious discrimination, such as being denied accommodations that would clearly not be an unreasonable burden for the employer or school, or being pushed out of your job or nursing program after disclosing your disability, knowing how to stand up for yourself becomes more important than ever.
Filing a discrimination complaint isn’t your only recourse—and it definitely shouldn’t be your first choice. “Try to see if you can get some resolution as close to the fire as possible,” says Maheady. “Is there a leader in the organization whom you can talk with to try to deal with the problem in a more effective way? Could you get a transfer to another unit? You need to explore every possibility for working it out internally.”
But if you’ve exhausted all of your internal resources without getting results, it’s crucial to do your homework about how the complaint process works.
Nursing students should start by reviewing their school’s grievance procedures. If going through the grievance process doesn’t end the discrimination, you can file a formal complaint against the school through the US Department of Education’s Office for Civil Rights (OCR). To find your nearest state or regional OCR, and learn more about how to pursue a complaint, visit www2.ed.gov/ocr. Students also have the option of suing the school directly rather than working with OCR.
Employment discrimination complaints are usually handled by the federal Equal Employment Opportunity Commission (EEOC). Unlike students, working nurses are required by law to file a complaint with the EEOC first before they can take their employer to court. EEOC complaints must be filed within 180 days of the date the discrimination occurred.
After the EEOC reviews your complaint, one of two things can happen. “The EEOC may decide that they will pursue your case against the employer,” says Jones. “Or they can issue a ‘Notice of Right-to-Sue’ letter, which gives you the right to go into the federal court system on your own and pursue the complaint with a private attorney.”
But before you decide to make such a drastic move, sit down and do some soul-searching about this question: Is it worth it?
“Be careful what you wish for,” Maheady cautions. “You have to ask yourself: Is this the hill you want to die on? If you lawyer up, do you think you’re going to be welcomed in that hospital? I’m not saying that suing your employer is never warranted. But I always advise nurses with disabilities to take that step very, very carefully.”
McCulloh agrees. “It’s not an easy process,” she emphasizes. “The right to sue still means that you need to have the financial resources to hire a lawyer, file a case, and take it to court. And it’s not a quick fix. Going through the legal process takes a very long time, which could put you in a situation where you’re not working, and not earning any income, for that entire period.”
Empower Yourself for Success
Ultimately, the most empowering pathway for nurses and students with mental health disabilities is to find positive alternatives that will let you create the best possible working or learning environment for your needs—one that will minimize your triggers and maximize your ability to succeed.
One way to do this is to connect with resource organizations that can provide advice and support—from university or employer disability services offices to peer advocacy groups, such as NOND and ExceptionalNurse.com, where you can network with other nurses who have similar disabilities to learn what’s worked for them. (See “Resources” sidebar.) These support systems can also help you identify employers who are more welcoming to nurses with disabilities because they recognize the value of having a diverse, inclusive, culturally competent nursing staff.
If you can’t change your current working conditions, or if you find that your job is just too stressful even with accommodations, consider following Copeland’s example of pursuing a specialty career niche that will be a better fit for you. For instance, one nurse from the ExceptionalNurse.com community (who asked to remain anonymous) comments: “I have bipolar affective disorder and I work as a clinical documentation improvement specialist. I couldn’t handle [bedside] nursing, but I found another area where I could be successful and use my clinical knowledge.”
Copeland offers this firsthand advice: “Don’t let yourself be defined by the fact that you have a mental health condition. If your goal is to be a nurse, or to be a nurse practitioner or a DNP, don’t let other people tell you that you can’t do that because of your disability. There are so many nurses out there who have multiple disabilities, and yet they’ve proved they can do it.”
By providing health education and wellness promotion in religious communities of color, minority nurses of all faiths can make a powerful difference in eliminating health disparities.
Not that long ago, nurses who answered a calling to promote physical and spiritual health in their places of worship were known as parish nurses or congregational health nurses. But in today’s unprecedentedly multicultural America, where many of the faithful are just as likely to attend a Muslim mosque or Hindu temple as a church or synagogue, this specialty area of nursing has acquired a new, more all-embracing name: faith community nursing.
“When what we do was first recognized by the American Nurses Association [ANA] as a specialty practice in the late 1990s, it was under the title ‘parish nursing,’” says Nancy Rago Durbin, RN, MS, FCN, interim director for faith community nursing for the Health Ministries Association (HMA), a professional association for faith community nurses (FCNs). But by 2005, when Durbin was part of a team working with ANA to update the specialty’s Scope and Standards of Practice, the limitations of that name had become glaringly obvious.
“One of the ANA leaders said: ‘Do you have to be Christian to claim this specialty?’” recalls Durbin, who is also director of Advocate Parish Nurse Ministry and the Parish Nurse Support Network for Advocate Health Care in the Chicago area. “When I said, ‘No, this is by no means an exclusive specialty, any nurse from any faith is welcome to practice,’ she said: ‘Well, your name doesn’t seem to include that.’ And she was right!”
Of course, the term “parish nurse” is still alive and well. It’s widely used to denote FCNs who work to improve health in specifically Christian settings. But professional organizations like HMA and the International Parish Nurse Resource Center (IPNRC), a ministry of the Church Health Center, now recognize that church-based nursing is one thread in a much bigger tapestry that encompasses many different faith traditions. In fact, the Church Health Center, despite its name, teaches FCN training courses to nurses of all faiths all over the world.
When and how did traditional parish nursing evolve into this broader, more culturally inclusive specialty? “I’ve always known it to be all-inclusive,” says Maureen Daniels, RN, MN, FCN, an IPNRC faith community nurse specialist. “I think it’s just the organic nature of it that’s helped it grow into more of these other faith settings. One of the things that’s so beneficial about this model is that it’s meant to be adapted to the community and to where the needs are.”
Different Faiths, Same Roles
No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Even though most FCNs do this work on a volunteer basis while also holding regular nursing jobs, they can make a tremendous difference in improving health outcomes and reducing health disparities in communities of color—especially those that are economically disadvantaged and/or medically underserved.
“[Places of worship] can be a very important resource for promoting health, because they reach so many people on a regular basis,” explains Ann Littleton, a congregational health advocate at Sacred Heart Catholic Church in Greenville, Mississippi, which serves a predominantly African American congregation plus a smaller Hispanic congregation. “At our church, we probably have more people from the community gathered together in one place every weekend than anywhere else. We can pass out information about cancer, heart disease, stroke, and diabetes just like we pass out the Sunday bulletin.”
The roles FCNs perform are remarkably similar from faith to faith. The Canadian Association for Parish Nursing Ministry organizes those functions into this easy-to-remember acronym:
H – Health advisor
E – Educator on health issues
A – Advocate and resource person
L – Liaison to faith and community resources
T – Teacher of volunteers and developer of support groups
H – Healer of body, mind, spirit, and community
For example, Ameena Hassan, RN, a Muslim nurse who works in the ICU at Las Colinas Medical Center in Irving, Texas, has been providing faith community nursing services at her mosque, the Islamic Center of Irving, since 2009. It’s a large mosque, serving approximately 500 families in the Dallas area.
“We do health education classes here every month,” says Hassan, coordinator of the mosque’s Health Advisory Committee. “We do blood pressure screenings and cholesterol screenings. We do mammograms every year, usually in April. During flu season, we do flu shots.”
The mosque also holds an annual health fair. At last year’s event—attended by almost 200 community members—local physicians, nurses, and dentists provided 100 cholesterol and diabetes screenings, 33 bone density screenings, 67 dental exams, and 42 vision exams. In addition, they gave 90 attendees nutrition advice and distributed 100 bicycle safety helmets to children.
At New Horizon Church International in Jackson, Mississippi, “cardiovascular disease is the number one health problem among my congregation, so we do lots of CVD screenings, education, and referrals,” says Ella Garner Jackson, RN, CHN, leader of the church’s Health and Wellness Ministry. Jackson and her team also provide a full calendar of other disease prevention programs, including exercise classes, kidney disease screenings, and HIV/AIDS education. On the advocacy front, the ministry helps increase access to health care for low-income church members by connecting them with community resources that provide affordable prescriptions.
Because Mississippi has some of the highest levels of poverty and African American health disparities in the nation—including disproportionately high morbidity and mortality rates from cancer, diabetes, and other chronic diseases—Jackson is especially focused on the FCN’s volunteer training role. In 2005, Jackson, who is also a cardiac case manager at Mississippi Baptist Medical Center, founded the Abundant Living Community Organization (ALCO), a nonprofit organization that has taught nearly 160 nurses and non-nurse volunteers to lead health ministries in African American churches throughout the state.
Same Roles, Different Needs
How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. In some faith settings, for instance, FCNs must tailor their health promotion activities to accommodate specific religious requirements.
“In Islam, we don’t mix men and women together in the mosque,” says Hassan. “If we’re doing something like screenings or flu shots, we have to have it in two separate places for men and women. And the women’s space has to be covered, because they don’t want to [expose their bodies] in front of others.”
But in many minority faith communities, the biggest challenges for FCNs are more likely to revolve around cultural and socioeconomic needs than belief-based ones.
“Here in the Chicago metro area, Advocate’s parish nursing program includes two Latino congregations and two African American congregations,” says Durbin. “Our nurses who work with those communities are very focused on the needs of people who are disenfranchised, undocumented, and struggling with access to care. Some of our nurses are dealing with the problem of food deserts, and they’re trying to work with the communities to create sustainable vegetable gardens and increase access to quality foods.”
Littleton, a retired English teacher who became a church health advocate after taking the ALCO training in 2010, emphasizes that “in our Hispanic health ministry, we don’t ask about immigration status. If anybody comes to us in need of our services or a referral, we try to make them feel as comfortable with us as possible. It’s important for them to feel that we’re not going to pry into their status; we’re just providing health services that they need.”
One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care.
“In some African American communities, there is still enormous distrust of the health care system,” Durbin notes. “A black faith community nurse can become the entry point for many people to develop that trusting relationship. Someone may say, ‘I went to the public health clinic down the street and they were mean to me. So I’m not going back.’ And the nurse will say, ‘Well, how about if I go with you? Because that’s where you need to be to get your meds refilled.’ Then the nurse can physically take that person back to the clinic and help them [build a better relationship with those providers].”
Durbin also notes, “In our Latino communities, men’s health is a big issue. Many of the guys have traditional machismo cultural values, so they don’t take care of their health. And traditionally, it’s the women and the older men who are the churchgoers, but not the younger guys. Latino faith community nurses who know the culture can figure out creative ways to engage that core group of men, such as providing them with health information through the people who love these men and who do go to church.”
Enlisting the aid of lay community health promoters can also help FCNs connect with hard-to-reach populations. Daniels cites the example of a group of parish nurses in Portland, Oregon, who are partnering with local promotores to extend their health ministry outreach deeper into the Hispanic community. “Because the promotores had such good relationships with the people, and people trusted them so much, they were able to get many more community members to come to health events the nurses had organized than the nurses would have gotten by themselves,” she says.
Bridging Cultural Differences
Even if a nurse doesn’t share the same religious, ethnic, or cultural background as the faith community he or she works with, collaborating with leaders within the community can be an effective way to bridge those gaps. For example, the Faith Community Health Ministry (FCHM) program at Carolinas HealthCare System in Charlotte, North Carolina, uses a model that makes it possible for the hospital system to meet the needs of virtually any belief community.
“We form partnerships with faith communities through either a faith community nurse or a faith community health promoter,” explains Sheila Robinson, BSN, RN, the program’s health ministry coordinator for Mecklenburg County. “My role is to help each one of those individual communities promote health and wellness within their own particular faith. I provide the clinical guidance and oversight to the nurses and the health promoters.”
This approach enables Robinson, an African American Christian nurse, to work with such diverse faith communities as the Hindu Center of Charlotte, a temple that serves about 2,000 families. Her health promoter partner is Chidaabha Vyas, vice president of the Hindu Center’s executive committee. When they first teamed up in 2012, one of their key projects was to survey the temple’s members about their most important health concerns and then develop programs targeted to those needs.
“Heart disease, allergies, and weight loss were some of the top concerns the community identified for us,” Vyas says. “Diabetes is a very big concern. And it’s not specifically the Hindu community that’s so affected by this disease,” she points out. “It’s [Asian] Indian people in general. Diabetes is more of a concern for us as a race, I would say.”
Being able to work side by side with a community liaison like Vyas makes it easier for both Robinson and Carolinas HealthCare System to serve the local Hindu community in culturally sensitive ways. “When we formed the partnership, I told Chidaabha, ‘I’m of Christian faith, so you will have to help me to be able to meet the needs at the Hindu Center,’” Robinson says. One cultural lesson she learned early on is that some members of this community may be uncomfortable with the idea of placing a terminally ill family member in hospice care.
“Again, this is more of an Indian cultural issue than a religious one,” Vyas stresses. “Some of us do not believe in speeding up the process of death. We believe death will come when it will come. Having a connection between our temple and the hospital system through the FCHM program is very helpful, because we can let them know that when an Indian family is resisting hospice it’s because there is a real cultural dynamic going on.”
A Higher Power
Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather together to pray, faith community nurses have the power to bring about real change.
“Because of our partnership with Sheila and the FCHM, something is happening at the Hindu Center now that was never happening before,” Vyas reports. “It has helped us develop a culture that prioritizes health. Before, health was thought of as more of an individual responsibility. But now, we’re beginning to develop a connection with our members based on the idea that ‘you are responsible for your own health, but the temple is here to help you be responsible for your health.’”
Jackson adds: “My pastor has told me, ‘I know that you’ve saved some lives in this congregation. I know that I am a healthier person myself because of all the education you’ve provided in the church.’ I can look out into the pews and show you people who were not going to the doctor, who weren’t taking their medicine, and who are now routinely seeing a physician. That’s at the heart of what a faith community nurse can do.”
