From Hogans to Hospitals

BYU nursing students learn lessons from diverse populations in Utah and around the world, experiencing new cultures and new approaches to nursing.

By Melissa Spalding Fritzsche (’11), Annie Allred Kirton (’10), Sarah J. Roberts (’11), Kelsey Moe Carter (’11), Danielle Davidson Nyholm (’11), Amy Sonntag Corson (’10) in the Fall 2010 Issue

Photography by Bradley H. Slade (BFA ’94)

Florence Nightingale, the founder of modern nursing, spoke of nursing as an art and a science, says Erin D. Maughan (BS ’95), assistant professor of nursing. “You can easily teach skills, putting in an IV—the science,” she says. “The course Global Health and Human Diversity focuses on the art and skill of human interaction.”

The College of Nursing designed this course to teach culturally competent care, a skill Maughan asserts is indispensable in the United States, with an increasingly diverse population and a health-care system on the verge of upheaval. “We’d like to think our nurses will be leaders,” she says.

In the course, students focus on specific populations in Utah and around the world. One section this year focused solely on integrative healing, another on veterans. Sections abroad transplanted students into health-care practices in Ecuador, Ghana, Tonga, and Taiwan.

“Culturally competent care is seeing the whole person, understanding where they come from, and realizing how that impacts their health,” says Maughan.

Here, BYU nursing students reflect on what they discovered about others and themselves as they learned the art of culturally competent care.

Inside a Sweat Lodge

Vickie Van Johnsen (BS ’85) and Leslie Wilden Miles’ (BS ’99) students put in full days at the Navajo Nation hospital in Chinle, Ariz. During their three weeks in Chinle, they taught in high schools and at the flea market, accompanied health aides on home visits, and provided community service. They also studied Navajo culture and traditions.

I sat next to a woman who came to have her feet healed. She placed her feet as close as she could to the pit where the hot rocks were placed. During each round, the “fire tender” passed hot rocks to the ceremony leader through the opening of the lodge, and the leader poured water over cedar and hot stones to create an aromatic and steamy room.

The sweat-lodge ceremony took place in a dome-shaped structure that was covered with a tarp and several blankets so that the interior was completely dark and, during the ceremony, very hot. What I found interesting was that the lodge and other hogans used for healing practices are located on the reservation’s medical campus; traditional healing practices took place on the same grounds as Western medicine. The ceremony I and other BYU nursing students attended was conducted through the Public Health Department at the hospital to help educate others about this tradition.

I loved hearing the singing during the ceremony. It was all in Navajo, so I didn’t understand what was being said, but I could feel the sincerity of the prayers that were offered. We were asked to sing, to drink water from the bull’s horn, and to pray with everyone. The experience was unlike any I have ever had.

The sweat-lodge experience was the beginning of my understanding of how two routes of healing are able to coexist on the reservation. It struck me that as a member of the Church I believe in blessings and the healing powers of faith. I could compare my beliefs with those of the Navajo people who turn to sweat lodges and other healing rituals to bring their bodies back into harmony or balance.

In my future nursing experiences, I will care for and work with individuals from different religious or cultural backgrounds. This experience at the sweat lodge helped me better understand that Western medicine is not the only solution. I learned the importance of understanding the traditional cultural and religious healing practices of the patients in our care.

—Melissa Spalding Fritzsche (’11)

Lessons in Jail

Students in nursing faculty Peggy Hammond Anderson’s (BS ’99) section focused on vulnerable and at-risk populations, and they didn’t have to leave Utah County to find them. The students attended patients at the Utah County Jail, completed rounds in the Utah Valley Regional Medical Center’s rehab and diabetes units, worked with the Food and Care Coalition to care for the homeless, and assisted at the Oakridge School, a school for children with challenges and disabilities.

The man came in high on meth. He couldn’t walk straight and was a bit disoriented, so the Utah County Jail staff put him into a cell to sober up. I was working in booking with one of the nurses, and I felt very critical of him. Later that day we booked him into the jail. As we assessed him and gathered his history, I learned that he had been taught to use meth by his father, a 26-year addict. I realized this man never really had a fair chance; he hadn’t been taught any other way to cope. As I talked with him further, I learned of his desperation to change. He said he was so frustrated and upset with himself that he sometimes had suicidal thoughts. My heart ached for him. While doing clinicals at the jail, I learned that a majority of inmates, like this man, had endured very difficult childhoods.

My experiences in this course made me sympathetic toward Utah County’s at-risk populations. As a nurse, I will be much more understanding when I care for inmates or the homeless. I like how one nurse at the jail put it: “They are already being punished by being in jail. We don’t need to further punish them by how we interact with them.” A nurse can have compassion for everyone, no matter their circumstances, mistakes, or history. Heavenly Father loves everyone, despite the mistakes they’ve made and the difficulties they have. I am much more likely to try to understand what others are going through and how they see things now that I’ve had these clinical experiences.

—Annie Allred Kirton (’10)

Quality, not Quantity

Making rounds in a 1,300-bed hospital and shadowing nurses in home-care visits in Taiwan, nursing instructor James Kohl’s students saw a modern health-care system they could compare and contrast with health care in the United States. Students observed how Taiwanese cultural values were manifest in health care, from the approach to caring for the elderly to the integration of religious or traditional healing beliefs.

We shadowed community nurses in Taiwan, and the memory that stands out to me was in a particularly poor patient’s home. It was 4 p.m., and I was supposed to be meeting with the other girls at our accommodations at 5, so my nurse preceptor and I did not have very much time. I followed her up to the door and straight into the home, where she called into the house. Family members of the patient came running to hug the nurse. They immediately started gabbing with grins on their faces. They brought us water bottles and fresh papaya, and we sat in their living room for the next half hour chatting. We had little time, and we hadn’t even seen the patient yet. Finally, the conversation dwindled and we walked into the patient’s room.

The nurse, in no rush at all, sat down at the patient’s bedside and began speaking softly. Feeling a little anxious about getting done in time, I reminded her that I had to be back within 20 minutes. She nodded, said, “I know,” and continued to take her time. Before she even began her nursing work, she stood up, motioned for us to go, and informed the family that she was going to drop me off and come back to finish up her work. Her shift was supposed to end in 15 minutes; however, it was 40 minutes round-trip to drive to my apartment and back to the home.

This simple experience was profound to me. What impressed me most was how my nurse took as much time as she needed to ensure that the patient’s family was coping well and that the patient was emotionally stable before she even began the physical care. Her focus was on quality and not quantity.

Too often in the United States I see nurses going through the motions, checking off their to-do lists in a hurry. They do not always take the time to get to know patients and their families. Caring for the individual and family as a whole—emotionally, spiritually, and physically—is going to serve and heal them better. At times it will simply not be possible to spend as much time as I would like with my patients; however, I can strive to provide more quality care.

—Sarah J. Roberts (’11)

Have a Good Life

Teaching the only veteran-focused nursing course in the country, nursing faculty Kent D. Blad (MS ’99) and Ron S. Ulberg (BS ’76), both veterans themselves, wanted their students to develop an understanding of the health-care challenges veterans face. The class traveled to Washington, D.C., where they met and worked with patients at Walter Reed Army Medical Center and visited war museums and memorials. Back in Utah, students made rounds at a veteran hospital and met with a panel of nurses at Hill Air Force Base.

Before this course, the only veteran I had really talked to was my grandpa, who is a wonderful man. But for the most part, I categorized veterans as harsh, intimidating people with whom I could not relate. During my first shift at the Garfield County Memorial Hospital, however, I realized how my perceptions had changed.

I helped a nurse care for a man, Jack, who came in with a bout of pneumonia. We went into his room in the morning to introduce ourselves and explain the plan of care for the day. As we examined his feet, we commented on how skinny and little his legs were. He laughed and replied that they have always been small, especially since surgeries to fuse his anklebones together. He had been shot down when he was a gunner in the Korean War, he explained, and the doctors fixed his ankles as best as they knew how. In response, the nurse said that at least it was not too bad of an injury. Jack seemed unsure of how to respond, and I left the room feeling very uncomfortable.

The next time we visited Jack, I asked him a little more about his service in Korea. He was not open to talking about his experiences. Instead, we talked about his first visit to Salt Lake City and seeing the Mormon Tabernacle Choir. He also told me how he had married the prettiest girl in Boston.

Even though Jack was not open to discussing his experiences in the military, I was grateful to establish a good rapport. I feel my experiences in Washington, D.C., where we learned about veterans and the issues they face after their military service, allowed me to establish a special nurse-to-patient relationship with Jack. Many experiences in Washington, D.C., including experiences at the Walter Reed Army Medical Center, changed my attitude toward veterans. At Walter Reed, we toured the rehabilitation clinic for amputees, and I talked with two veterans who were both injured during their service in Iraq. One had lost his leg after stepping on an improvised explosive device. As we talked, I realized he was just like any other man in his early 20s. The only difference was his experience in the Army.

Then I had a profound experience at the Iwo Jima Memorial. Each of us was assigned to present the story behind and significance of one of the war memorials in Washington, D.C. When I gave my presentation at the Iwo Jima Memorial, I stood next to one of the men who’d stood on those beaches as the Americans stormed Iwo Jima. My professors had invited him to hear the presentation and then tell us about his experiences. I was moved beyond words. A “thank-you” with a handshake seemed inadequate. To our words of gratitude, he responded, “Have a good life. That’s why we did what we did.” The words of this veteran summed up how my life was changed by my experience in Washington, D.C. I am going to enjoy life, and I will never hesitate to look a veteran in the eye and genuinely thank him or her.

—Kelsey Moe Carter (’11)

On the Tongan islands Vava’u, Tongatapu, and ’Eua, Shelly Jensen Reed (BS ’83) and Jane Hansen Lassetter’s (BS ’98) students worked in clinics and hospitals, assisting in labor and delivery, immunizations, and even dental checkups. They also took health care door-to-door, visiting islanders’ homes to educate and conduct interviews for an infant-nutrition study.

Sophia was the first woman in Tonga we helped deliver a baby, and her delivery was also the most meaningful to me.

In Tonga they use little or no pain medication for labor. Culturally, they are not encouraged to express pain. In the deliveries we observed, I never noticed any of the Tongan nurses attempting to ease their patients’ pain with comfort measures. The Tongan nurse delivering Sophia’s baby kept shushing Sophia whenever she hinted that she was in pain.

Though we were straying from the Tongan cultural idea of birth, we did a lot of “comfort measures” to try to ease Sophia’s pain during contractions. Some of us were with her all day long. She seemed to like our being there. I held Sophia’s legs and put upward pressure on them while she was pushing. I was right there when the baby came out.

Sophia was so tired after the labor. This was her first baby and, after his birth, she said she never wants another one. All Sophia received for postpartum pain was Tylenol.

The next day, when we checked on Sophia, her husband told us that they were so grateful for what we had done for Sophia that they wanted us to give their baby boy a first name. I was shocked and honored. All of the BYU nursing students thought about it together, and we eventually came up with Brigham—the only name we could think of that involved all of us.

Baby Brigham’s father had each of us write down our names and where we are from so he can show it to Brigham when he is older. The trust that this family put in us was incredible and really helped me to realize the impact I can make as a nurse. This experience will remind me that patients sometimes consider their nurse to be a very important part of their life experiences.

Involving our own culture in deliveries did not seem to be a bad thing, as all of the mothers we helped expressed gratitude for our assistance. I realized that pain is not always expressed the same way, but patients still feel pain and appreciate having it controlled.

—Danielle Davidson Nyholm (’11)

Baby Brigham

Making a Difference Where I Can

Students in nursing faculty Karen Miller Lundberg (ADN ’79) and Cheryl Skousen Corbett’s (BS ’89) inner-city section focused on refugees in the Salt Lake City area, working at a day care center for children of refugees and a free clinic that services a high volume of patients with language barriers. A small group of students attended church in a Swahili-speaking branch and were assigned to visit and plan nursing interventions for a refugee family.

A few nursing students and I had the opportunity to work with a refugee family from Burundi, Africa, living in a Salt Lake City apartment. Picture a family transplanted from one of the poorest countries in the world to a new continent where they face an unfamiliar language and culture. While they are not living on the streets, they do struggle with economic challenges and delays in health-care access. We made weekly visits to their home to assess their needs and work on nursing interventions to help them adapt to life here.

When we met this family, they had been in Utah for a little over a year. In that time the father had suffered a stroke and the mother had discovered she had diabetes. We assisted the father with physical therapy and taught the family lessons on exercise and nutrition.

Communication was sometimes difficult, as their native language is Kirundi. The children often served as interpreters for their parents. One day we asked what we could do, and the mom said, through her daughter, that she wanted us to teach her how to read. This took us by surprise. The mother opened a workbook to the page she wanted to start with. She would read short sentences, then we would teach her the vocabulary words for different pictures—guitar, lion, goat, and others. On other visits we would play our own version of UNO; each person had to say the number and color, in English, each time he or she played a card. It was a way for everyone to spend time together, have fun, and practice English. We couldn’t provide her with all the help she needed, but we could do a little every visit.

Of all the nursing interventions we provided, this one was the most meaningful. Helping them overcome the language barrier will open more opportunities for them to learn, gain employment, function in their new environment, and improve their access to health care. It was just as important as our lessons on nutrition and exercise.

I learned that, as nurses, sometimes we need to go to where our patients are to provide culturally appropriate care. It is important to assess what people have to work with, what their immediate needs are, and what their values and beliefs are so we can help them in the way that will do them the most good.

As I work as a nurse, I want to save lives and cure people; however, that won’t happen every day. I learned from working with our refugee family to not be afraid to do what I can to make a difference, even if it seems small compared to the bigger goal.

—Amy Sonntag Corson (’10)

NOTE: All patient names have been changed to protect privacy.

Learn more at more.byu.edu/ghhd or support the course at give.byu.edu/nursing.

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