ENTRAR            

CONSENSUS

International Symposium on Community Nursing Research
Granada (Spain), Escuela Andaluza de Salud Pública, 2007 October 4-5

Round Table
Building culturally competent community nursing care*

Jody Glittenberg (speaker)
PhD, RN, FAAN, AHNC, TNS. University of Colorado. Colorado Springs, USA

Manuscript received by 23.12.2007
Manuscript accepted by 27.8.2008

Index de Enfermería [Index Enferm] 2010; 19(2-3): 134-136
*Contents of the Round Table developed inside the International Symposium on Community Nursing Research moderated by Doctor Sally Kendal, Director of CRIPACC and Professor of Nursing. University of Hertforshire, UK

How to cite this document

Introduction: A new beginning

    "Go to the People, Live with the People, Love Them, Learn from Them, Start with what They know, Build on what They want, so that when you leave They will say, 'We did it ourselves."
    This Chinese motto was on the wall of Doc Berhorst's Guatemalan highland hospital where I first encountered (in 1971) a man of vision, a missionary doctor who saw empowering the illiterate, impoverished Mayan Indians, as a way to build healthy people, healthy communities. Doc viewed hospital-oriented medical care as a Band Aid on the real health problems that were: malnutrition, sanitation, illiteracy, poverty, and powerlessness. Following eleven years of work in the developing Republic, I followed Doc's holistic, social advocacy method in teaching graduate students a new way of looking at communities and systems. I called the method, Project GENESIS (General Ethnography and Needs Evaluation In a System), a new beginning using an ethnographic research method (meaning 'a picture from the peoples' points of view). This model has been used for over 25 years with the graduate community health students at the University of Colorado. A number of other universities have also used this grassroots, partnership model for designing and sustaining healthy communities.
    The method begins by applying the Chinese motto -"Go to the People..."- with each cohort of students. Students develop a shared partnership with the community before they even begin their semester long co-created project. The students live with the people learning how the people see health problems and what resources they have to solve them. Some of the communities have not been towns but other systems such as a nursing home or a prison. In the end, a co-created plan of action is shared at a public presentation. New community health projects spring from this original Project GENESIS.

Destiny shared as Partners

    No longer can we as community health nurses merely manage disease, but we must build partnerships to promote health at all levels of communities (ANA 2000; Anderson, Gutherie, Schirle 2002; Winkler and Wallerstein 1997; Roberson 1999; www/healthypeople, 2002). All parts of a community, not only the social institution of health, but also of families, religion, education, law and political power, and economics, are critical to healthy communities. Healthy communities through their own decisions to maximize on their strengths and eliminate their weaknesses are empowered. Cultural diversity is viewed as a strength ( Drevhahl 1999; Glittenberg 2001).

Community as a cultural entity

    Empowering communities includes celebrating cultural diversity as a strength. A community is a cultural entity embracing cultural beliefs and behaviors of all individuals within that system. Migration occurs globally, and communities are confronted continually with new transitions, new cultures. Culture acts as a protective factor by setting standards and norms of what is acceptable and unacceptable behavior. Discerning and understanding these cultural standards of each community or system is important if alliances are to proceed to a partnership. Culture entails not only the present behavior, but also the history of the group, the ecology, the demographics, and the primary written and spoken language. Culture binds ethnic, religious or social groups together. Community, thus, may be viewed as a system of individuals, in networks of shared cultures (Glittenberg 1997). "In nursing we must refuse to go backwards by defining health in relation to the limits of the hospital wall or the narrow definition of an illness. We must go forward, clearly seeing our role as promoters of health for all (Glittenberg 1988)".

Project GENESIS: An Ethnographic Action Research Model

    The following research study of a violent community, Esperanza (a pseudonym) is illustrative of how Project GENESIS is useful in addressing transitions as identified by the community. The problem identified is violence, the number one public health problem in the world.
    It was called the Summer of Violence -1993- as homicide and assault statistics broke all records. Triggered by the death of a promising young boy in a drive by shooting the Esperanzans in a small border town rallied saying "No mas". For decades the townspeople had been living in fear from gun-toting gangs and rival drug dealers. They asked me, a researcher, to help them find out why their town was more violent than others. Funded by the National Institute on Drug Abuse (NIDA), the research method used was Project GENESIS. We lived with the townspeople in a low-income housing settlement apartment in the middle of the most violent area of town. Also we had a storefront office on main street. About 50 students from various disciplines from three universities in the area had short-term experiences with us. We lived as good neighbors, as partners, living like all in this poverty stricken town.
    As good neighbors we participated in all types of community activities, like the fiestas, planting gardens, attending churches services, holding health clinics, acting as victim advocates, leading social skill groups, writing grants for police and social service agencies, sponsoring parties for children, and counseling individual families. The people trusted and accepted us; the team learned about all aspects of living in the town and why it was more violent than towns. We saw the community as client.
    We found there were three distinct cultural subgroups within the town: (a) a minority (1/3) of resilient, settled old timers; (b) a majority (2/3) of undocumented Mexican immigrants; and (c) an unknown number of drug-traffickers, including gang members and prostitutes. This third subgroup had a covert presence that created fear in the other citizens. After compiling data from the people, the citizens applied for and received a US Department of Justice `Weed and Seed" grant (meaning to weed out the "bad" and seed in the "good" policy). With matching funds that reached a total of $13 million, the town, with a population of only 5, 500 people, began a transformation.
    The grant money was distributed by the citizens themselves to make many changes in the physical appearance of the town such as the streets were paved, sidewalks put in, crack houses torn down. The crime statistics dropped by half as the police force was doubled and participated more face to face with the people. People began to come out of their houses, no longer afraid. Women mobilized to reduce consumption of liquor. For example, they surrounded a violent bar and stayed 24 hours a day for over a month to halt all business. The bar was closed and never opened again.
    In spite of very visible improvements in the appearance of the town, drug trafficking from the border continues. The great disparity in wealth between the US and Mexico-only 45 miles apart creates envy and opportunity. Immigrants illegally cross the border in the U.S., where some make a living through drug trafficking. Most townspeople are hardworking but many are complicit in drug dealing. Others are complacent about the trafficking-saying, "what can one person do?" Until public policy related to drug sales and use is changed and the unequal status between the two nations is resolved, trafficking and violence will likely remain. In spite of this continuing problem, progress is being made and hope is growing.

Summary

    Cultural competence at a community level is learned by studying the culture from the peoples' points of view. They are the teachers. Through such awareness of the cultural diversity, partnerships can be formed and plans of action based upon their perceptions and resources. A culturally proficient community can be a co-created entity.

References Cited

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