Empowering, energizing and exhausting are terms sometimes used by family nurse practitioners Tim Rausch and Ricky Norwood to describe work with underserved populations. Both agree it is also rewarding.
Rausch, RN, MSN, FNP, sees patients at the UCLA School of Nursing Health Center at the Union Rescue Mission in downtown Los Angeles. He provides primary care for patients who often are homeless. Presenting with an acute need such as an abscess, the flu or a headache, his exams often reveal patients have undiagnosed chronic diseases. “They might have hypertension with a pressure over 200 [systolic], or blood glucose above 400,” Norwood said.
Most clients, he said, also have mental health or substance abuse concerns. Poor health literacy often adds to the issues these clients face.
While some patients return for chronic disease management, he said others never come back. Averaging 15 patients a day, Rausch performs well-child exams and screenings along with adult care.
The patient base is somewhat similar at the Sacramento County Health Center where Norwood, DNP, MSN, RN, FNP-BC, sees patients. The county clinic is associated with the Betty Irene Moore School of Nursing at UC Davis in Sacramento through a first-of-its-kind cooperative agreement. As an assistant clinical professor with the SON, Norwood works in the clinic’s new Healthy Partners program. The program, according to the county’s health and human services website, provides primary and preventive healthcare to low-income, undocumented adults residing in Sacramento County.
Long, but rewarding days
“We work very long, but rewarding days,” Norwood said. “I come in energized and leave exhausted.” He said 80% of patients have never had healthcare, so he performs a thorough history and physical exam, then proceeds with care based on the findings. Most patients are Hispanic, require an interpreter, and common findings include diabetes, hypertension and thyroid disease.
Norwood said he takes true pleasure in this work, because as a child growing up in Mississippi, he had no healthcare access. “I understand these patients’ need and issues,” Norwood said. Likewise, Rausch, a former ICU and critical care nurse, chose to specialize in primary care for underserved populations because he believes it helps prevent hospitalization, and even disability and death for many of his patients.
He first sampled the work as an NP student on rotation and is convinced it’s an exceptional experience for NP students. “Students very quickly become immersed in the social determinants of health,” Rausch said. “Instead of learning about lab values and diagnoses, they’re learning what got these patients to where they are and how that impacts [the patients’] health. Students learn how to develop strategies for patients that empower them to take control of their health, It’s a unique kind of experience.”
Norwood, who will begin precepting NP students at the Sacramento clinic this summer, agrees. “You can’t get a better model of care than this,” he said. “It’s totally holistic care.”
Skills required to serve the underserved
Success in treating underserved populations demands energy and top skills, both NPs assert. Rausch said a natural affinity toward patient education is also valuable.
“So many of the issues involved with poor health in this population are due to poor health literacy,” Rausch said. “As we give them the knowledge they need about their conditions, and encourage them to return for follow-up care, we can prevent really bad outcomes that will land them in the ER or a hospital.”
Being creative and committed to find a way to connect with each patient and develop a relationship is also necessary.
Norwood added, “If you want a job that will challenge you on a daily basis, give you an opportunity to lift up others and give back, you’ll never have a dull moment. You’re rocking and rolling from the time you start until you leave.”
The investment of skills and patient connection pays off, according to Rasuch. “In the end, it’s rewarding to know that we are helping the patients who otherwise may not be receiving care,” Rausch said
What defines an underserved community?
Many people in Guyana face the problem of lack of physicians to meet their basic needs of health care. Underserved community can be described as a situation whereby there is one physician per 3000 persons who should be served. In many clinics, there is lack of doctors to serve in those clinics and this is alluded to the factor that most of them have run away due to current specialization of medical practitioners and even technological advancement. Underserved communities face the problem of lack of good health insurance cover making them not to have preventive measures. At the same time they will have poorer outcomes as a result of chronic illnesses including diabetes mellitus, cancer and cardiovascular disease. This communities also face problems of lack of physicians that can give them primary care and also health resources. Other factors include lack of transport system, low income level and education, limited health literacy and lack of English fluency. The most vulnerable are the women and children. The poor in addition face problems that are associated with health from the developed countries that emit dangerous gases (US Department of Health and Human Services, 2008). They also have the problem of inadequate information as far as health services and care is concerned.
Lack of education as a factor that contributes to underserved communities mostly in women has made them to have a challenge in receiving critical care mostly in terms of maternity. Many of them lack insurance cover and to those who have, the cover is inadequate. Those who are not insured face challenges such as postponed prescriptions and delayed screening for diseases such as cancer. In regards to education, they are negatively affected by the academic and social culture of the institution in that it does not match their standards when compared with that of the well served groups. In most cases, they withhold their questions in order to avoid confrontation. Other terms that are used to define underserved communities are patients with low income that is below 200% of the federal poverty level, patients having medical disabilities or those who are residing in a geographically isolated region or those who are confined to a residential setting. For example, rural areas have few dentists per capita making it difficult to schedule visits with the dentist.
Those who are confined in residential settings such as nursing homes, prisons and even chronic care facilities for the mentally and physically challenged individuals are likely to get limited care and at the same time they are poor such that they cannot get care privately. Lack of primary care physician who are graduating have been in the decline in the past due to decreased reimbursement of primary care services, increased student debt and even perceived prestige and lifestyle preferences. Students who graduate are advised to have early positive clinical experiences with community health centers immediately after their graduation within the community health centers. It has also been realized that internet usage by underserved community to access information is very low but those who can access, use it less frequently as a tool of improving their health standards. In serving the underserved, one needs to identify the unique characteristics of each individual and at the same time to be sensitive to their needs, concerns and issues. To this regard, a number of states have come up with different ways to help address the issue of underserved. This by instituting effective strategies to serve underserved groups, this includes mobile van units, providing of materials by use of different language, country extension agencies, use of health IT. Individuals have also volunteered to help in addressing the issue of underserved by offering their services to them.
Some of the things that I have learnt that can help me to care about the underserved is that I have to know them first, their situations in terms of family, culture, social, challenges and barriers that they face in dealing with their illnesses and other factors that could have contributed to their illness. Based on this knowledge, I will be in a position to serve them according to my capability. In addition, there are motivational factors that have encouraged me to work for the underserved includes the desire to make a difference in someone’s life and the desire to serve them. In addition, I also have a view that this type of work is a calling and it goes beyond my social or material needs. The advantages of doing this to the communities who are underserved are that there is satisfaction to the patients and positive impacts on their lives. In addition, there is a motivation in terms of the challenge for the kind of job done rather than for money. This kind of job is challenging in that it gives one an advantage to use his sense of humor in providing medical care to the patient, this is because in most cases, the patients that one is dealing with are always in chronic conditions or diseases that had never been diagnosed before hence its upon the physician to provide the care (US Department of Health and Human Services, 2013). While gaining experiences in college, the curriculum encompasses very many course units thereby giving me an advantage of dealing with a variety of various kinds of illnesses.
Further, my experience with the knowledge of health IT enables me to serve the underserved patients in that I can easily access information By sensitizing them on the importance of health IT, they can get the right information that can improve patient education. The health includes electronic health records and personal health records. Use of It will in addition help in exchanging data of a particular patient with relevant clinical stakeholders. This use of technology will play a very important function in ensuring that the right information is there for the right person of a given underserved community in real time. With this data in place, it will help one to know the sources of disparities in the health sector for underserved. This will help in improving the health sector as there will be a rich set of data that can be used as source of reference.
In conclusion, the problem of other communities being underserved still exists within US in which case most of the vulnerable groups are women and children. These communities have low income and the major problem is that they lack proper health insurance cover making them not to have proper prescriptions or screening for such diseases like cancer. Lack of education in addition has also contributed hugely to the problem where patients are not in a position to get enough information about health. It has also been realized that there are few physicians to serve the patients.
US Department of Health and Human Services. (2013). Health professional shortage areas. New York: Nova Science Publishers.
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