Nursing 381: Cross-Cultural Engagement with Families (1 Semester Hr.)

Nursing 381: Cross-cultural Engagement with Families (1 semester hr.) CCE Integral Course Credit

SEMESTER 4 September 1, 2001

RECOMMENDATION: The Nursing Department recommends to the Science Division and Educational Policy Committee the approval of the course, N381 “Cross Cultural Engagement with Families”, as a regular course in the Nursing Department curriculum.

COURSE TITLE: NURS 381, Cross Cultural Engagement with Families

1. Full Title for Catalog: Cross Cultural Engagement with Families 2. Course Number: NURS 381

CREDIT HOURS FOR THE COURSE: 1

PREREQUISITES: Successful completion of Nursing 307, 308, 309, 327, 328, 329, 357, 358, 359

SEMESTER/SESSION/YEARS WHEN THE COURSE WILL BE OFFERED: Spring semester each year.

CATALOG DESCRIPTION:

NURS 381: Cross Cultural Engagement with Families (1)

This seminar course provides the student the opportunity to complete and to reflect on the long-term relationship with a family that began in the first semester of nursing courses. Long-term relationships can result in a deeper level of learning about how to work with families and with persons from different cultural backgrounds to promote and protect their health. Over the course of the semester, students will make the last three home visits to their long-term family. As the two years of visits to the family are completed, students will finish portfolios begun with the first family visit. During three, two-hour seminars with their faculty advisor, students will reflect on their experiences considering the role of the Reformed Christian nurse and the role of culture, values, and beliefs (both their own and those of their family) in health promotion and health protection with families in the community.

EXPANDED COURSE DESCRIPTION:

Course Objectives During this course students will: Evaluate the importance of Christian service in professional nursing practice for families in the community. Integrate core virtues into interactions with families in the community.

CCE Model – On-campus course with CCE woven through curriculum 1 Synthesize family assessments, plans, interventions, evaluation (i.e. nursing process) and resources into family portfolio. Evaluate the role of cultural beliefs and values in health promotion and health protection. Analyze how their own world view and that of their family fit together and how this affected their care. Synthesize what they learned about themselves, their own culture and faith, and about caring for others.

Course Outline Session One: To prepare for this seminar, students will read a minimum of 4 sources related to the culture of their client/family. They will reflect on and discuss the following questions. Describe the culture of your client/family related to elements of Leininger’s Sunrise Model. Does what you read about your client’s culture fit with what you know about your client? How are these the same as/different from your culture? What are the beliefs of your client/family related to health, illness, health promotion, healing, the health care system? How do these fit with your views/beliefs? How did these cultural factors affect the care you provided? What will you take with you as you continue to care for clients who are culturally different from you?

Session Two: To prepare for this seminar, students will first research the client’s faith/denominational beliefs and then attend a worship service at the client’s church. If the client/family has no church affiliation, the student will attend a service of a church that would fit with the client’s particular culture. They will reflect on and discuss the following questions: What is the world view of this person/family? What is the world view of the cultural group of this person/family? What are the cultural embodiments of faith for this person/family? For this culture? How did these values, beliefs and practices fit with your world view and with your own cultural embodiments of faith? Were there any values, beliefs or practices that were in conflict with your own views? How did you deal with these areas? *Note: It will be important to emphasize the answering these questions involves more than just reflecting on the worship service experience.

Session Three: To prepare for this seminar, students will need to complete their portfolios, and to provide written reflection on the following questions. These questions will also be discussed in seminar. Reflecting on your experience over the last two years, what have you learned about yourself? What have you learned about your own culture? What have you learned about caring for others?

CCE Model – On-campus course with CCE woven through curriculum 2 What have you learned about your faith? How did the core virtues inform your interactions with this family? How have your experiences with your family impacted your beliefs about your own Christian service in the profession of nursing?

REFORMED CHRISTIAN PERSPECTIVE:

God put all humans in this world in relationships. We have relationships with persons, families and friends. Further, we have a special relationship with God himself. In this seminar course students have the opportunity to reflect on a relationship with a family developed over a two year time period. They will consider how these relationships developed and grew and the affect the relationship had on the health of the family. Students will especially examine how cultural values and beliefs affected the partnership between the student and their family. Because we believe that, as Christians, we must work to redeem all of this world for Christ, it is imperative that our students learn to work with and learn from people of many cultural backgrounds. This course affords students the opportunity to reflect on how a Reformed Christian world view affects relationships and thereby the health of the family and assists to enhance the student’s development as a nurse and as a Christian professional.

CORE VIRTUES:

As nurses we use a variety of virtues in our work with clients and families. In this course students will explore for themselves which of the core virtues were challenged and strengthened while working with a family over an extended time period. Although all core virtues may have been addressed at some time over the course of the two-year relationship with the family, each student will reflect on which virtues were most impacted by this experience.

TEACHING METHODS:

Discussion, student presentations, role-plays, written reflection

TEACHING MATERIALS:

Student portfolios, posters

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CCE Model – On-campus course with CCE woven through curriculum 3 Proposal for CCE Integral Course Nursing 381 – “Cross Cultural Engagement with Families”

Introduction:

The newly approved and soon to be implemented nursing curriculum is a carefully integrated set of courses and experiences which will prepare an entry-level professional nurse with a core body of knowledge, competencies, and abilities germane to nursing and based on a Reformed Christian worldview. The Cross Cultural Engagement Course proposed for the nursing department, though here packaged as a separate course, is indeed the culmination of cross-cultural education and experiences across the four semesters of the upper division nursing major. The course described below is only a portion of the cross-cultural education and experiences nursing students will receive as they learn in the classroom and interact with clients in a wide variety of settings. It is not possible to quantify the number of hours of direct interaction nursing students will have with clients of various cultural and ethnic backgrounds over their last two years at Calvin. On a weekly basis they will interact with people from every race and ethnic group represented in the greater Grand Rapids area, assisting them to maintain their health and caring for them on an intimate basis for extended hours at a time. Though the proposed cross cultural engagement course is an attempt to "guarantee" a certain experience, in reality it is only a part of what nursing students will learn about people and their various lifeways across the semesters, and is only a portion of the close personal engagement students will have with people of various cultures.

Each semester for four semesters students will discuss culture in the classroom and laboratory in the nursing strategies courses: N308, N328, and N358. They will be presented with didactic information about culture and diversity from a Reformed Christian worldview, will learn how to communicate in an appropriate fashion with persons of various cultural backgrounds, will learn about their own cultural awareness through various exercises and role plays and will learn how to do appropriate cultural assessments for families, for persons with mental health needs, persons across the life span and communities as a whole. They will practice communication and assessments in a laboratory setting to gain proficiency, then use this knowledge and these competencies in every practicum course over the four semesters. They will do exercises to learn about their own prejudices and raise consciousness about how they interact with people of diversity. They will learn what culture is using the definitions of various nursing theorists, the most notable of which are Dr. Madeline Leininger, Dr. Joyce Giger and Dr. Ruth Davidhizer. These authors point especially to values, beliefs and lifeways as differences among cultures, rather then assuming that a person of a certain race is also of a certain culture. Values, beliefs and lifeways differ widely among both ethnic and socioeconomic groups.

It is important to note that socioeconomic groups can be included when considering cultural variations. Consider the differences in values and lifeways between the upper and lower socioeconomic classes, for instance. Although not traditionally considered different cultures, if considered in this light it becomes clearer how those folk who live in poverty

CCE Model – On-campus course with CCE woven through curriculum 4 can be considered to have their own culture. They have different values, believe differently about some things and certainly have different lifeways than those groups with higher incomes. Across ethnic groups there are similarities in the values, beliefs and lifeway of people in the various socioeconomic strata. It can be a challenge to understand a different culture, and even more difficult to empathize with them, simply because of the differences in values, beliefs and lifeways. Nurses working with clients of different socioeconomic backgrounds will readily attest to the challenge of understanding and working with clients of a different socioeconomic status than their own. So nursing students will certainly find that experience to be helpful to them in learning about caring for other cultures.

Nursing students will be required on a semester-by-semester basis to interact with clients of various cultural backgrounds, both ethnic and socioeconomic, in a caring, sensitive manner and to reflect on their experiences verbally and in reflective journals. In their practicum experiences they will care for people in hospitals, clinics, neighborhood centers, senior citizens centers and the like and be expected to provide culturally sensitive care for a wide range of cultural groups. And all this outside of the cross-cultural engagement course itself. So as the following rationale is considered it is important to understand that the CCE course itself really does not stand alone in the nursing curriculum, but instead is a capstone course for the cultural engagement students will experience in all other nursing courses across the nursing curriculum. Additional specifics can be obtained by examining the other nursing courses. l. Describe the direct experience activities that will be part of the course:

In the first semester of the four semesters of the upper division nursing major, students will be assigned to work with a family from one of the neighborhoods with whom we have partnerships. These neighborhoods are very different from each other and are also very different culturally from the backgrounds of the students. Baxter neighborhood is predominantly Black-American, Creston neighborhood is predominantly Caucasian from the lower socio-economic class and Burton Heights neighborhood is predominantly Hispanic. Families will be chosen by nurses in the health clinics in each neighborhood, or by school personnel if the clinics are unable to find as many families as we need. These families will all have need of health promotion, health teaching or health protection, with specific needs varying with the age and health status of the members. Students will work in pairs to provide assistance with health care to these families over a two-year period. Students will begin in the fall of their first semester in the upper division nursing courses and meet with the family a minimum of three times each semester for four semesters. The intent is to have the student meet with the same family over this two-year period to allow both the family and the student to establish a close relationship and learn about each other and to trust each other. A continued relationship that extends over four semesters will ensure that the student truly understands the family and their values, beliefs and lifeways and is able to provide nursing care sensitive to that culture.

Normally these meetings with the family will take place in the home of the family and would last about one and a half hours. Students will be able to absorb the culture of the

CCE Model – On-campus course with CCE woven through curriculum 5 family as they spend extended periods in their homes, using all their senses to grasp who a family is and how they live. Students will assess the health needs of all family members using a variety of assessment tools and will then develop plans to meet the specific health needs of the family. In addition they will do general health teaching with the family as needed. Since the student's role is to assist the family in whatever they see as their health needs, the student will first work with the family to determine how they can best help them, then provide teaching or other services which will meet the needs of the family. The agenda will be set by the family with the nursing student responding to the needs of the family as mutually determined. Although Nursing 381 as a one credit hour course is only required in the last semester of the nursing major, nursing students will be involved with the families during all four semesters of the program. In the first three semesters, instruction, discussion and reflection on the family visits will be included in the nursing strategies course for that semester (N308, N328, N358). In the last semester, credit will be given for their cross- cultural work in the formal CCE course attached, N381. In addition to home visits with a family in the final semester, students will attend three seminar sessions to reflect on their experiences.

2. How will these experiences be cross-cultural?

In the Baxter neighborhood, which is predominantly Black-American, and the Burton Heights neighborhood, which is predominately Hispanic, students will be working with families who hold cultural values, beliefs, and lifeways that are clearly different from their own. In addition, most of these families will be from the lower socio-economic class. A life of poverty also carries with it different values, beliefs and lifeways than mainline, middle class America. So with these families students will be able to experience not only an ethnic culture different from their own, but also a socio-economic culture different from their own.

In the Creston neighborhood, which is predominantly Caucasian, families may be of different cultural backgrounds such as Polish, Somali, Bosnian or Italian. Both refugees and families descended from a diverse set of ethnic backgrounds live in this neighborhood. The heritage they carry down through their families from their immigrant ancestors will still be retained in many ways. But the clearest cultural differences between families in this neighborhood and the nursing students will be in the different culture created by poverty. Students will not have any trouble identifying how people from the lower socio-economic class in this neighborhood have different values, beliefs and lifeways from their own. Nurses who work in the community will quickly verify that working with families who live in poverty challenges all of their own values and beliefs, a true test of cultural differences.

Approximately one-third of the nursing students will be in each of the three neighborhoods. They will spend time each semester in their neighborhood doing health promotion nursing in the community in homes, schools, churches, senior citizens' residences and the like. They will also be caring for clients in the acute care settings to which they are assigned, such as Pine Rest Christian Hospital, Spectrum Health and

CCE Model – On-campus course with CCE woven through curriculum 6 Metropolitan Hospital. Here they will all have cross-cultural experiences on a regular basis. Students spend 12 hours each week for four semesters in these various settings, so the opportunities for interacting with people of various cultural and ethnic backgrounds are numerous. Students will be sharing their experiences working with people of various cultures in the strategies and practicum nursing courses each semester over the four semesters of upper division nursing courses. In lab settings and in practicum conferences students will use the experiences they have had with persons and families of different cultural groups to reflect with their peers about what they have learned about themselves, about others, and about how culture affects their nursing care.

3. How will students be oriented to the culture or cultures?

As stated in the introduction, students will begin to learn about culture as a concept in N 308, one of the three nursing courses in the first semester of the upper division nursing major. Here they will be presented with didactic information about culture and diversity from a Reformed Christian worldview. Students will then spend a laboratory session learning about the expectations for working with families over the four semesters. Here they will be given their family's name and other pertinent information. They will then determine which ethnic or cultural group the family belongs to and will do research about that culture prior to their first visit with the family. They will meet with a faculty member prior to each visit to verify that they are prepared to interact with the family. They will also go through a formal cultural assessment with the family sometime in the first semester of working with them. The student will be expected to be sensitive to cultural norms as they interact with the family over the four semesters. In the following nursing strategies courses, N328 and N358, students will learn how culture affects nursing care of pregnant women, infants, children and adults. They will then apply what they learned when they meet with their families that semester. In the final course, N381, students will formally reflect on questions of culture, reading sources and reflecting on how the family's culture interfaced with their own over the two year period.

4. How will faculty guide reflection?

Although the course described here includes three reflective sessions, there will be reflection at various junctures throughout the four semesters of the upper division nursing major. Each semester, during the laboratory section of the strategies course, there will be time set aside for the faculty member to discuss family visits with the students. Here they will both reflect on what they had already done and plan for the next visit. Students will have written assignments to complete for each home visit with the family. A portfolio of these assignments will be turned in at the end of each semester. These will be graded and returned to the student. In the final course, "N381 Cross Cultural Engagement with Families", the student will spend seminar sessions in specific reflection about the long- term relationship with the family considering the role of the Reformed Christian nurse and the interface of culture, values and beliefs. The course objectives and the outline for the three sessions show clearly how students will reflect on this experience and how faculty will guide this reflection.

CCE Model – On-campus course with CCE woven through curriculum 7 Session one of N381 is the capstone for work done throughout the four semesters on culture. Students are required to research the culture of their assigned family in the very first semester as a preparation assignment for their second home visit. They will also do a formal assessment of the culture of the family using a published nursing assessment tool devised by Gieger and Davidhizer and/or Leininger. The professor assigned to the student at that time will direct discussion and evaluate this piece. As they proceed to work with the family for two years, they will glean more information about the culture of the family and will be able to thoughtfully reflect on those items proposed in session one of the N381 course.

Session two of N381 is also the capstone for work done earlier in the relationship with the family. The nursing faculty is currently considering whether to move the worship experience into the first semester of nursing, with some discussion done at that point of the educational process about what it is like to worship in a facility, be it church, synagogue or mosque, which is out of the student's comfort zone. Students would then have a broader and deeper understanding of the family as they work with them. But final reflection on the whole experience would be most beneficial in. N381, as the student has matured to a deeper understanding of the culture of the family.

5. How will faculty evaluate student attainment of CCE objectives?

Nursing students will keep portfolios of their visits with their assigned family throughout the four semesters of meeting with them. These portfolios will contain written assignments as required in each semester. One of these will be a cultural assessment during the first semester. In successive semesters, culturally appropriate plans will be expected. These will be graded at the end of each semester for thoroughness, ability to meet expectations of the course, depth and breadth of assessments and plans for the health of the family.

In the final semester, in N381, students will meet in three seminars with a faculty member to reflect on the cross-cultural experience. They will turn in the final, completed portfolio of their work with the family. This will be evaluated as stated above. In addition, student discussion, presentations and written reflection will be expected in this final course. Faculty will evaluate the student on breadth and depth of thoughts, on investment in the seminar and on the students' ability to articulate, both verbally and in writing the objectives of the course: to evaluate the importance of Christian service in professional nursing practice for families in the community, to integrate core virtues into interactions with families in the community, to synthesize family assessments, plan, intervention, evaluation and resources into family portfolios, to evaluate the role of cultural beliefs and values in health promotion and health protection, to analyze how their own world view and that of their family fit together and how this affected their nursing care, and to synthesize what they learned about themselves, their own culture and faith, and caring for others.

CCE Model – On-campus course with CCE woven through curriculum 8 Calvin College Department of Nursing Nursing 381 Cross Cultural Engagement with Families Spring, 2004

Course Credit Hours: 1

Times: The course will meet for three, two-hour seminars over the course of the semester. Students will also continue with their two Family Visits per semester as part of this course. You have already fulfilled a portion of the requirements for the course through the Family Visits you have previously done.

Faculty: TBA

Course Description: This seminar course provides the student the opportunity to complete and to reflect on the long-term relationship with a family that began in the first semester of nursing courses. Long-term relationships can result in a deeper level of learning about how to work with families and with persons from different cultural backgrounds to promote and protect their health. Over the course of the semester, students will make the last two home visits to their long-term family. As the two years of visits to the family are completed, students will finish portfolios begun with the first family visit. During three, two-hour seminars, students will reflect on their experiences considering the role of the Reformed Christian nurse and the role of culture, values, and beliefs (both their own and those of their family) in health promotion and health protection with families in the community.

The Context for this Course: God put all humans in this world in relationships. We have relationships with persons, families and friends. Further, we have a special relationship with God himself. In this seminar course students have the opportunity to reflect on a relationship with a family developed over a two year time period. They will consider how these relationships developed and grew and the affect the relationship had on the health of the family. Students will especially examine how cultural values and beliefs affected the partnership between the student and their family. Because we believe that, as Christians, we must work to redeem all of the world for Christ, it is imperative that students learn to work with and learn from people of many cultural backgrounds. This course affords students the opportunity to reflect on how a Reformed Christian world view affects relationships and thereby the health of the family and assists to enhance the student’s development as a nurse and as a Christian professional.

Course Objectives: During this course, the student will: Synthesize learning about themselves, their own culture and faith, and about caring for others. Analyze how their own worldview and that of their family fit together and how this affected their care.

CCE Model – On-campus course with CCE woven through curriculum 9 Synthesize family assessments, plans, interventions, evaluation (i.e. nursing process) and resources into family portfolio. Evaluate the role of cultural beliefs and values in health promotion and health protection. Integrate core virtues into interactions with families in the community. Evaluate the importance of Christian service in professional nursing practice for families in the community.

Course Policies:

For Grading policies, see Policy #125 in the Calvin College Department of Nursing Student Handbook. In courses with more than one unit, a student must successfully complete the first unit in order to progress to subsequent units. (Policy #110 Calvin College Department of Nursing Student Handbook) Assignments are expected to be completed by their due date. Without PRIOR arrangement the grade for a late assignment will be reduced by 10 percent of the total possible points for each day late excluding weekends. (Policy #125 Calvin College Department of Nursing Student Handbook) Calvin College will make reasonable accommodations for persons with documented disabilities. Students needing academic adjustments or accommodations are requested to speak with the professor within the first two weeks of class. Students should also notify the Coordinator of Services of Students with Disabilities located in the Student Academic Services Office. Each student is expected to sustain high ethical standards by exhibiting appropriate behavior as delineated in the Calvin College Student Conduct Code Book and the Calvin College Department of Nursing Student Handbook. See appropriate policies in each.

Course Evaluation: Family portfolio 30% Seminar participation 25% Reflection papers 45%

Course Evaluation Details: Family Portfolio: After their final Family Visit, students will turn in their complete Family portfolio. This will include all information collected at each visit, all teaching plans with resource materials, all bib cards and references, and any other materials used throughout the course of working with this family. (30%)

Seminar Participation: The seminar participation grade will be based upon three parameters. These include: Attendance – 30 points Preparation – 30 points Participation – 40 points Because this class meets only three times, attendance at all class sessions is imperative. Students who fail to show evidence of consistent preparation for class sessions may lose up to 30 points for lack of preparation.

CCE Model – On-campus course with CCE woven through curriculum 10 Students who do not participate in class discussions and activities may lose up to 40 points even if they attend class. (25%)

Reflection Papers: For each of the three seminar sessions, students will write a 3-5 page (of text) reflection paper in which they answer the questions posed for that seminar. It is expected that these will be true and accurate reflections, and that they will be in-depth reflections. If asked to use references to prepare for seminar, provide a list of these in APA format. (each paper is 15% of course grade)

Family Visits: You are again required to make two Family Visits this semester. Due dates for the written assignments r/t the visits are due on February 23 and April 12. Note that you have only 2 weeks after Spring Break to make your second visit. Please plan accordingly. (30%)

SEMINAR SESSIONS

Class #1 – Week of February 16, 2004 Cultural Aspects of Family Visits

During this class session, the student will: Evaluate the role of cultural beliefs and values in health promotion and health protection. Synthesize what they learned about themselves, their own culture, and about caring for others.

To prepare for this seminar, you must read a minimum of 4 sources related to the culture of your client/family. In writing, reflect on and discuss the following questions. (15%) Describe the culture of your client/family related to elements of Leininger’s Sunrise Model. Does what you read about your client’s culture fit with what you know about your client? How are these elements the same as/different from your culture? What are the beliefs of your client/family related to health, illness, health promotion, healing, and the health care system? How do these fit with your views/beliefs? How did these cultural factors affect the care you provided? What was the most difficult aspect of working with this family? Why? What was the most rewarding aspect of working with this family? Why? What will you take with you as you continue to care for clients who are culturally different from you?

Class #2 – Week of March 15, 2004 Faith, Worldview, and Family Visits

During this class session, the students will: Analyze how their own world view and that of their family fit together and how this has affected their care. Synthesize what they learned about themselves, their faith, and about caring for others.

CCE Model – On-campus course with CCE woven through curriculum 11 To prepare for this seminar, you must first research your family’s faith/denominational beliefs and then attend a worship service at their church. If your client/family has no church affiliation, attend a service of a church that would fit with your family’s particular culture.

GUIDELINES FOR VISIT TO WORSHIP SERVICE

1. PREPARATION:

C.S. Lewis says, in The Problem of Pain, "Why else were individuals created, but that God, loving all infinitely, should love each differently? And this difference, so far from impairing, floods with meaning the love of all blessed creatures for one another, the communion of the saints. If all experienced God in the same way and returned Him an identical worship, the song of the Church triumphant would have no symphony, it would be like an orchestra in which all the instruments played the same note."

To be able to discern divine revelation through new and different cultural vehicles requires openness, trust, the ability to be at least minimally self-critical, and the willingness to refrain from making assumptions. It means that you must be willing to admit that your understanding of God has come through the "dark glass" of your culture and personal experience. This experience is only a partial revelation of the truth.

In preparation for attending a religious service from a denomination or religion different from your own, identify and read one reference about the sacred writings and basic tenets of that religion. This will help you understand what is happening and the meaning of the service as you observe.

2. ACTIVITY:

Attend a religious service from a denomination or religion that is different from your own and fits with you family’s ethnic group. If possible, attend where your family goes to church. Throughout this experience, attempt to put yourself in the participants' shoes and attempt to understand what this means for them, not just what it means to you from your values and perspective. (15%)

3. REFLECTION: (in writing) a. Cite the reference that you read in preparation for this learning activity and state what you learned that helped you prepare for attending this service. b. Provide the name and address of the house of worship that you attended. Give the date of attendance. If possible, attach a bulletin or order of worship. c. Describe the environment, the presence/absence of religious symbols, musical, dramatic, and verbal/nonverbal methods of worship. Discuss

CCE Model – On-campus course with CCE woven through curriculum 12 similarities and differences to your usual or previously experienced worship service. d. Describe your own feelings as you participated in this worship experience. e. What is the worldview of this person/family? e. What is the worldview of this person/family? f. What is the predominant worldview of the cultural group of this person/family? g. What are the cultural embodiments of faith for this person/family? For this culture? h. How did these values, beliefs and practices fit with your world view and with your own cultural embodiments of faith? Were there any values, beliefs or practices that were in conflict with your own views? How did you deal with these areas? i. What you have learned about yourself and your own style of worship as a result of this experience? j. How does the above affect how you interact with this family? How does it

affect how you care for them as a nurse?

Class #3 – Week of April 19, 2004 Impact of Family Visits on Your Own Practice of Nursing

During this class session, the student will: Evaluate the importance of Christian service in professional nursing practice for families in the community. Describe how core virtues were integrated into interactions with families in the community. Synthesize family assessments, plans, interventions, evaluation (nursing process) and resources into the family portfolio.

To prepare for this seminar, you must complete your Family po rtfolio. It will be turned in at this seminar session. In writing, reflect on and discuss the following questions (15%). Reflecting on your experience over the last two years, what have you learned about yourself? Is it easier or more difficult to provide nursing care to people when you are on “their turf”? Why? What have you learned about your own culture? What have you learned about caring for others? What have you learned about your faith? How did the core virtues inform your interactions with this family? How have your experiences with your family impacted your beliefs about your own Christian service in the profession of nursing? h. How will these experiences inform what you do if you practice in an acute care setting?

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CCE Model – On-campus course with CCE woven through curriculum 13 CALVIN COLLEGE DEPARTMENT OF NURSING

FAMILY HOME VISIT GUIDELIINES PURPOSE:

The family home visits are designed to introduce the nursing student to the concepts of health promotion/health protection, family and community based nursing in a cross cultural context. In the first year, the student will focus on the assessment phase of the nursing process, utilizing skills in observation, interpersonal communication, data collection and analysis. A variety of assessment tools will be used to guide the student in the collection of data, which will describe the family’s health status. In the second year the student will focus on the implementation and evaluation phases of the nursing process concentrating on appropriate health promotion and health protection s trategies for the family. Students will use skills of teaching and learning. During this year the professional relationship will continue to develop and eventually terminate.

As the student works with a family group, he or she will develop skills in assessing both individuals within the family group and the family itself as a client. Students will have the opportunity to become acquainted with a family from a different culture than their own. Since the family was established at creation by God the Father, remains the most central institution in society, and is one of the major client groups for community nurses, students will learn to work with families in their own community setting.

The family as client provides the student with opportunities to collect and analyze data related to the family unit and its development. As the most significant influence on an individual’s health beliefs and values, the family will impact the health practices and status of its members. Recognizing that the nurse in any practice setting must consider the client as a member of a family, this introduction to the family will emphasize the client as a member of a family, influenced by and influencing the family.

OBJECTIVES:

Identify the stages of a professional relationship as experienced through professional cross- cultural interactions with a family. Value the culture of the family Assess the family’s strengths and needs Describe environmental factors which influence the family’s health Use identified family assessment tools appropriately to collect data Implement and evaluate a culturally sensitive plan for health promotion and health protection with the family Evaluate one’s own learning experiences associated with working with a family from a different culture from one’s own.

7/12/01 TEXTBOOKS Craven, R.F. & Hirnle, C.J. (2002). Fundamentals of nursing: Human health and function. 4th ed. Philadelphia: Lippincott

CCE Model – On-campus course with CCE woven through curriculum 14 Edelman, C. L., & Mandle, C. L. (2002). Health promotion throughout the lifespan. 5th ed St. Louis: Mosby. Hitchcock, J.E, Schubert, R.E., & Thomas, S.A (2003). Community health nursing. Caring in action. 2nd Ed. Clifton Park, NJ: Delmar. Hunt, R. (2000). Readings in Community Health Nursing. Philadelphia: Lippincott.

PREPARATION FOR VISITS

Each student will be assigned to a family at the beginning of the first semester of the junior year and, if possible, will continue to visit the same family during the following three semesters. A faculty member will also be assigned to answer questions that arise during the semester and to grade the completed work at the end of each semester. As much as possible, a junior and senior student will be paired to make visits to the family, each student responsible for different components of the visit. Each semester a discussion will occur in the nursing strategies lab course to explain the home visit requirements for that semester. Here the student will establish goals for the semester as well as a tentative schedule for making the required visits. The student is expected to have reviewed the assignment for working with the assigned family prior to the class. Readings for each visit must be completed prior to the visit.

WRITTEN WORK

The importance of record keeping in nursing interactions is emphasized in the development of a legal record of interaction and remains as a continuous record of data collection and analysis. The written record will remain with the student in a portfolio of work. At the end of each semester the portfolio will be turned in to the faculty member for grading. Upon its return the student will retain it and continue to compile the portfolio, adding new work to previous records. As necessary and appropriate, the student, in consultation with his/her assigned faculty member, will communicate with the referring community agency about the family.

Some of the forms for each semester are included on the following pages. Those included are marked with an asterisk (*). Other forms must be obtained from identified sources. Nursing health sheets for health promotion/health protection are available for student use. These health sheets are on the computers in the nursing media center or at the neighborhood practicum site. They are in a software package called “Krames-on- Demand”. It is the student’s responsibility to choose a teaching plan appropriate to the needs of the family, update it using nursing research and individualize it for the specific family. The student must complete a bibliography (bib) card about each journal article for each visit. The bib cards are to contain the reading’s reference information in APA format and a short paragraph summarizing the information presented in the article. A second short paragraph will explain how the student will use the information with the family. Bib cards can be submitted in typed form on letter size paper or hand written on 5X7 note cards.

CCE Model – On-campus course with CCE woven through curriculum 15 GRADING:

During the first three semesters of family visits, portfolios will be graded pass/fail. Instructor comments will assist the student to recognize areas of strength and areas for improvement. Evaluation and grading will occur in the last semester of family visits when the student in enrolled in N381, Cross Cultural Engagement with Families. The family visit portfolios are worth 30% of the grade in N381.

OVERVIEW OF SEMESTER EXPECTATIONS

Below you will find a schedule of assignments for two years. Each year will be done separately. It does not matter which year is done first with the family, since after one year is competed, the other year will follow it. Students in their first semester of nursing will be considered juniors and students in their third semester of nursing will be considered seniors. If you are a junior you will follow the instructions for a junior student the first year you work with a family and if you are a senior you will follow the instructions for a senior student the second year you work with a family. Items marked with an * are included in this document.

FALL SEMESTER (A)

VISIT #1- Get acquainted

JUNIOR Reading: Edelman: Chapter 4, pp. 100-102, & pp. 182-184. Hunt. Article 20, pp. 154-160 Hitchcock: Chapter 21 and Chapter 24, pp 613-614, p. 620 Figure 24-18

Completed forms to be included in portfolio: Family identification form (demographic info)* Ecomap (Hitchcock, pp. 613-614) Phases of the Professional Relationship – orientation phase - family*

SENIOR Assist Junior with establishing a relationship and completing ecomap Reading: Hitchcock: Chapter 24, pp 613-614, p. 620 Figure 24-18 One research article from a professional journal on family nursing. (Student’s choice)

Completed forms to be included in portfolio: Family identification form (demographic info)* Ecomap (Hitchcock, pp. 613-614) Establishing a relationship – orientation phase - mentor* Bib card on article

CCE Model – On-campus course with CCE woven through curriculum 16 VISIT #2 – Family Assessment and Teaching for Need

JUNIOR Reading: Hitchcock, Chapter 25 One research article from a professional journal on family nursing. (Student’ s choice)

Completed forms to be included in portfolio: Family Assessment – Hitchcock, p. 642, figure 25-8 Working phase of professional relationship - family* Bib card on article

SENIOR Reading: As appropriate for patient need One research article from a professional journal on teaching topic for family health needs

Completed forms to be included in portfolio: Teaching plan specific to family needs, i.e., chronic conditions, maternal or child health, heart disease – Include the Krames-on-Demand health sheet used. Teaching Review* Bib card on article Working phase of professional relationship – mentor*

SPRING SEMESTER

VISIT #1 – Nutrition and Teaching for Need

JUNIOR Reading: Edelman, pp. 282-283, box 11-2 One research article from a professional nursing journal on nutrition and health

Completed forms to be included in portfolio: Nutrition assessment* Bib card on article

SENIOR Reading: As appropriate for patient need One research article from a professional journal on teaching topic for family health

Completed forms to be included in portfolio:

CCE Model – On-campus course with CCE woven through curriculum 17 Teaching plan specific to family needs, i.e., chronic conditions, maternal or child health, heart disease – Include the Krames-on-Demand health sheet used. Teaching Review* Bib card on article

VISIT #2 – Environment and Nutrition

JUNIOR Reading: Hitchcock, Chapter 24 pp. 609 – 612, 620 One research article from a professional journal on enviornment . (Student’s choice)

Completed forms to be included in portfolio: Environmental Assessment* Bib card on article

SENIOR Reading: Edelman, pp. 282-283, box 11-2 One research article from a professional journal on nutrition (Student’ s choice)

Completed forms to be included in portfolio: Teaching plan on nutrition specific to family needs – Include the Krames-on-Demand health sheet if used, or else own plan. Teaching Review* Bib card on article Termination phase of professional relationship- family* Termination phase of professional relationship – mentor*

FALL SEMESTER (B)

VISIT # 1 –Get Acquainted

JUNIOR Reading: Edelman: Chapter 4, pp. 100-102, & pp. 182-184. Hunt. Article 20, pp. 154-160 Hitchcock: Chapter 21 and Chapter 24, pp 613-614

Completed forms to be included in portfolio: Family identification form (demographic info)* Genogram (Hitchcock, p. 614, Figure 24-13) Initiation of professional relationship – orientation phase- family*

CCE Model – On-campus course with CCE woven through curriculum 18 SENIOR Assist Junior with establishing a professional relationship Reading: Hitchcock: Chapter 21 and Chapter 24, pp 613-614 One article from a professional journal on family nursing. (Student’s choice)

Completed forms to be included in portfolio: Family identification form (demographic info)* Genogram (Hitchcock, p. 614, Figure 24-13) Bib card on article Initiation of professional relationship – orientation phase- mentor*

VISIT # 2 – Culture and Teaching for Need

JUNIOR Reading: Craven: Chapter 20, pp. 325 - 339 Craven: Chapter 30 pp. 649-660 One article from a professional journal about the culture of assigned family (Student’s choice)

Completed forms to be included in portfolio: Cultural Assessment* - asterisked items only for this visit Bib card on article Working phase of professional relationship - family*

Completed forms to be included in portfolio: Teaching plan specific to family needs, i.e., chronic conditions, maternal or child health, heart disease – Include the Krames-on-Demand health sheet used. Teaching Review* Bib card on article Working phase of professional relationship - mentor*

SPRING SEMESTER

CCE Model – On-campus course with CCE woven through curriculum 19 VISIT #1 – Stress and Teaching for Need

JUNIOR Reading: Craven: Chapter 40 pp. 1325-1338 One research article from a professional journal on stress

Completed forms to be included in portfolio: Life Stress Assessment – Craven: Display 49-4, p. 1338 Bib card on article

Completed forms to be included in portfolio: Teaching plan specific to family needs, i.e., chronic conditions, maternal or child health, heart disease – Include the Krames-on-Demand health sheet used. Teaching Review* Bib card on article

VISIT # 2 – Health Promotion and Stress management

JUNIOR Reading: Pender, chapter 7 (developing a health promotion/protection plan) (on reserve) One research article from a professional journal on working with families in a community setting. (Student’s choice)

Completed forms to be included in portfolio: Strengths and competencies of family and individuals (Pender, pp. 147-151) Bib card on article

SENIOR Reading: Craven: pp. 1336 - 1342 One research article from a professional journal on stress management and health (Student’s choice)

Completed forms to be included in portfolio: Stress management teaching – Include the Krames-on-Demand health sheet used Teaching Review* Bib card on article Termination phase of professional relationship - family* Termination phase of professional relationship - mentor*

CCE Model – On-campus course with CCE woven through curriculum 20 Student Name______

CALVIN COLLEGE DEPARTMENT OF NURSING

FAMILY HOME VISITS

DATES OF VISITS:

SEMESTER 1 ______

SEMESTER 2 ______

SEMESTER 3 ______

SEMESTER 4 ______

CCE Model – On-campus course with CCE woven through curriculum 21 FAMILY DEMOGRAPHIC FORM

HOUSEHOLD MEMBERS (NO LAST NAME)

FIRST NAME GEN- AGE OCCUPATION PLACE OF DER OR GRADE EMPLOYMENT OR SCHOOL FATHER

MOTHER

OTHER IN HOUSEHOLD

CCE Model – On-campus course with CCE woven through curriculum 22 PHASES OF THE PROFESSIONAL RELATIONSHIP (for use with families)

Describe your communication activities in relation to each element of each phase of the professional relationship.

ORIENTATION PHASE: (VISIT 1)

1. Initiate contact Describe how you contacted this family to initiate the relationship. How did you decide what to call each other? How did you decide on the location and time of the meeting?

2. Establish a contract: Describe how you worked through a) the purpose of the meeting b) the length of the meeting c) the frequency of the planned meetings d) mutual expectations e) confidentiality

3. Self goals: Identify two goals you had for yourself for this first meeting

4. Therapeutic response: Describe one use of a therapeutic communication technique you used during this visit with the family.

5. Reflections: Describe your feelings about the first visit? What went well? What might you do differently next time?

CCE Model – On-campus course with CCE woven through curriculum 23 Professional Relationships (for use with families) WORKING PHASE (fall semester, visit 2)

1. Establishing trust: Describe how you established trust with this family. When did you feel it begin? How might you continue to build trust?

2. Interventions: Explain how you knew you were getting through to the family as you went through your teaching, or why not. Were you able to direct the conversation?

3. Communication skills: a) Give an example of how you used a therapeutic communication technique during this visit. b) Give an example of a blocker that you used in communication this visit and explain a better technique.

4. Cultural sensitivity: Give an example of how your intervention or communication was done in a manner that was specifically designed for the culture of this family.

5. Reflection: Describe your feelings about this visit? What went well? What might you do differently next time?

CCE Model – On-campus course with CCE woven through curriculum 24 Professional Relationships (for use with families) TERMINATION PHASE (Spring, visit2)

1. Preparation: Describe how you prepared yourself for this last visit, emotionally. Describe how you prepared the family for this last visit.

2. Goals met: Review the gains made and goals met with the family.

3. Goals remaining: List any goals that the family still wishes to accomplish

4. Ending: Describe how the visit terminated and the family’s reaction.

5. Self reflection: Describe your own feelings about terminating the relationship with the family.

6. Best and worst: What do you think was the best and the most difficult part of conducting these visits with the family?

CCE Model – On-campus course with CCE woven through curriculum 25 PHASES OF THE PROFESSIONAL RELATIONSHIP (for use as a Mentor)

Describe your communication activities in relation to each element of each phase of the professional relationship as a mentor.

ORIENTATION PHASE: (VISIT 1)

1. Initiate contact Describe how you contacted your junior partner to initiate the relationship. How did you get acquainted? How did you decide on the location and time of your first meeting or contact?

2. Establish a contract: Describe how you worked through a) the purpose of the meeting/contact b) the length of the meeting/contact c) mutual expectations

3. Self goals: Identify two goals you had for yourself for this first meeting/contact

4. Therapeutic response: Describe one use of a therapeutic communication technique you used during contact with your junior partner.

5. Reflections: Describe your feelings about the first meeting/contact? What went well? What might you do differently next time?

CCE Model – On-campus course with CCE woven through curriculum 26 Professional Relationships (for use as a Mentor) WORKING PHASE (fall semester, visit 2)

1. Establishing trust: Describe how you established trust with your junior partner. When did you feel it begin? How might you continue to build trust?

2. Communication skills: a) Give an example of how you used a therapeutic communication technique during this second meeting/contact. b) Give an example of a blocker that you used in communication and explain a better technique.

3. Personal sensitivity: Give an example of how you exhibited sensitivity to your junior partner or communicated in a manner that was specifically designed for her or him.

4. Reflection: Describe your feelings about this meeting/contact? What went well? What might you do differently next time?

CCE Model – On-campus course with CCE woven through curriculum 27 Professional Relationships (for use as a Mentor) TERMINATION PHASE (Spring, visit2)

1. Preparation: Describe how you prepared yourself for this last meeting/contact, emotionally. Describe how you prepared your partner for this last meeting/contact.

2. Goals met: Review the progress in your relationship with your junior partner over the year.

3. Goals remaining: List anything about the relationship with your junior partner that you wish had been different.

4. Ending: Describe how your meeting/contact was terminated and your partner’s reaction.

5. Self reflection: Describe your own feelings about terminating the relationship with your partner.

6. Best and worst: What do you think was the best and the most difficult part of the relationship with your partner?

CCE Model – On-campus course with CCE woven through curriculum 28 TEACHING REVIEW FORM (use for each teaching encounter)

1. State the title of the teaching form that was used. State modifications made to personalize the form for this family.

2. State how the standard teaching plan was or was not culturally appropriate for this family.

3. Explain the area that went most smoothly. Why do you think it went well?

4. Explain the area that was most difficult to teach the family. Why do you think that was the case?

5. How did you determine if the family understood what was taught?

6. Did they learn what you had hoped they would learn? Did they learn what was important to them?

CCE Model – On-campus course with CCE woven through curriculum 29 CULTURAL ASSESSMENT USING LEININGER’S SUNRISE MODEL (Semester B, Fall, Visit 2 and Spring, Visit 2) Please use this framework for collecting information about the culture of your family. DO NOT use the questions as stated here to ask the family questions. They are for your use in writing up the results of your assessment. Much of this information can be obtained in general conversation and through observation. The asterisks (*) are on items that should be addressed by the end of the first semester. The remainder should be addressed by the end of the second semester. It may not be possible to address every item listed, but the more complete you are the better you will understand your assigned family.

1. Kinship/Social Factors *-Who is considered to be in the family – e.g. mom, dad, grandparents, aunts? -What are their roles in the family? Are there expected gender roles? What are the duties of each member? *-How do members interact? (from your observation) -Who makes decisions about money, health, children and how they are raised?

2. Cultural Values and Lifeways *-Physical appearance and dress (from your observation) *-Daily activities of household members *-Environmental context – symbols, cultural objects, space and time orientation -Communication patterns – eye contact, touch, language, non-verbal communication -Diet – typical foods, beliefs and taboos about food -Beliefs about the person and relationship with nature -Traditions surrounding birth, passage to adulthood, marriage, loss and death -Art, music, dance, literature -Holidays and celebrations

3. Religious/Philosophic Factors -What is important in life -Purpose and meaning in life -Religion and its beliefs, practices, rites, celebrations *-Place of worship

4. Political/Legal Factors *-Feelings about democracy, American government -Beliefs about what makes for good citizenship -Feelings about upholding authority and the law

5. Economic Factors *-Who is the primary wage earner in the family? -Importance of money. How is it earned, saved, spent? Is income shared among family members? What financial obligations are considered most important? -Donations to groups, organizations, individuals

CCE Model – On-campus course with CCE woven through curriculum 30 6. Educational Factors *-Years and level of education of family members -Importance of education for success in life -Informal vs. formal education -What is a person willing to do to receive an education? -Gender differences in educational expectations

7. Technological factors *-Technology used in daily life i.e. Phone, computer, answering machine -Feelings about technology and technological progress -Feelings about use of technology in health care

8. Health -How is it defined? -Beliefs about the cause of illness *-What practices are important for maintaining health and preventing disease? -Who is consulted and who makes decisions about health? -Who pays for health care? -Use of professional health system -Use of lay health system – i.e. Folk treatments, lay healers -Attitudes towards pain and suffering and how these should be managed *-Health problems, diseases most common in this culture

Leininger, M.M. (1991). Culture care diversity and universality: A theory of nursing. New York: National League for Nursing Press.

CCE Model – On-campus course with CCE woven through curriculum 31 SAFETY/ENVIRONMENTAL ASSESSMENT (Semester A, Spring, Visit 2)

Please use these items for collecting information about the environment of your family. This data can be gathered through observation. The questions stated here are for your use in writing up the assessment and SHOULD NOT be used to ask the family directly. It may not be possible to address every item listed, but the more complete you are the better you will understand your assigned family.

Neighborhood Environment

Are the dwellings and streets well kept or deteriorating? How and when is the garbage collected? What is the incidence of crime? What is the population density? Is public transportation available? Is it used?

Home Environment

What type of dwelling is it? (condominium, apartment, mobile home) Are the interior and exterior in good repair? (trash, broken stairs, peeling paint) Are the number and type of rooms adequate for the size of the family? Is there adequate lighting, heat, water and sewer supply? Are there smoke detectors and an escape route and plan? Is there a telephone? Are emergency numbers posted? Is there an alternate plan if there is not a telephone? Are first aid directions posted or available? If there are children, are there appropriate safety measures in the home? (door locks, plug covers, stair gates, poison control, safe bedding, play areas, fences)

Family Health Environment

What are some of the family activities that would affect health? (nutrition, exercise, sleeping practices, medical checkups, smoking, alcohol, drugs) How does the family use and store medications? Is the home understimulating or overstimulating? 4. Are there risk factors present for infections or diseases? Where does the family go for medical and dental care?

Adapted from: Edelman, C. L., & Mandle, C. L. (2002). Health promotion throughout the lifespan. 5th edition. St. Louis: Mosby.

CCE Model – On-campus course with CCE woven through curriculum 32 NUTRITION ASSESSMENT (Semester A, Spring, Visit 1)

Diet History 1. Do you have any medical problems that affect what you can or may eat? If yes, please describe. ______

2. Have you recently gained or lost more than 10 pounds? If yes, explain the surrounding circumstances. ______

3. Do you eat at regular times during the day? ______How many times per day? ______

4. Do you usually eat snacks? ______When?______

5. What foods do you particularly like? ______

6. Are there foods you don’t eat for reasons other than that you don’t like them? ______

7. Do you have any difficulty eating? Explain ______

8. How would you describe your feelings about food? ______

9. Do your eating habits change when you are emotionally upset? ______

10. Do you drink alcohol? ______How much? ______How often? ______

11. Are there any other facts about your lifestyle that you think might be related to your nutritional health? Explain ______

CCE Model – On-campus course with CCE woven through curriculum 33 Usual dietary pattern (recall from today and/or yesterday)

1. Did you take a vitamin-mineral supplement? ______If yes, what kind? ______

Please recall with me the amount and type of food and beverages you consumed today (or yesterday to get an entire day’ s worth) Begin with breakfast and proceed through the day. Include snacks.

Food Amount Beverage Amount Description (how Portion/cups Portion/cups cooked)

Analyze for food groups and amounts Food group Amount per day Above or below recommended? Bread, cereal, rice and pasta Fruit Vegetables Milk, yogurt, cheese Meat, poultry, fish, dry beans, eggs, nuts Fats, oils, sweets

CCE Model – On-campus course with CCE woven through curriculum 34 Beverages: Sugared Healthy Contain caffiene

CCE Model – On-campus course with CCE woven through curriculum 35