Engaging Students in Community Partnerships Equals Plain Learning

1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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 immuni- zations

8. 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

9. The Beginning: Challenges and Outcomes

10. Diverse Projects 1995-2001 • Poster on buggy safety • Paper on the Evolution of Health Beliefs • Cancer Brochure, multiple field trips • Honor thesis on Maple Syrup Urine Disease

11. 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

12. 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

13. 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)

14. Examples of Educational Topics • 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

15. Blood pressure screening Glucose screening Lipid screening Bone density screening Dental care Immunizations Preventive Care

16. Additional Projects and Studies • Accuracy of Portable Lipid Analyzer Study • Colorectal Cancer Screening Project • Burn study: B & W and Leaf Therapy • Obesity Study • Well Child Screening • Hearing Screenings

17. 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

18. Challenges • Establishing and maintaining the relationship requires much time • Maintaining cultural appropriateness • Avoidance of technology • Cost • Participatory model

19. Benefits: Community/Faculty • Community members • Use of participatory model • Improved health care • Faculty • Networks formed between the community and the universities • Research opportunities

20. Benefits: Students • 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

21. 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.

22. 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.

23. 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.

24. 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.

25. 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. Jones, P.J. & Field, W.E. (2002). Farm safety issues in old order Anabaptist communities: Unique aspects and 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.

26. Questions?