How Culture-sensitive Are Your Camp Health Services?

November 2015
Heart with bandages

Campers and staff come from a variety of backgrounds. An urban-savvy camper becomes the bunkmate to a youth raised on a rural farm; two girls — one from a small mountain village and the other from a coastal metropolitan area — are in the same cabin; and U.S. staff are joined by staff from other countries. In addition, there may be campers and staff who, while living in the U.S., speak a language other than English at home. This seemingly disparate group interacts to create the magic of camp. Each person’s background — his or her beliefs, practices, and mores — color and influence the quality of his or her interpersonal experiences. But that magic doesn’t happen serendipitously.

Camp professionals work to establish the camp’s culture. From precamp planning to opening day arrival and throughout the camp experience, an assimilation process is launched, one experienced by both campers and staff. It often replaces the individual’s culturebound background with the camp perspective, and we hear things like, “That’s the camp way!” or “We do it like this around here.” The result is “our” campers and staff.

Adaption to the camp way typically goes well; camp professionals are adept at orchestrating it. But that may not be the case in the health center, an area of camp where culture-bound beliefs can be extremely impactful. Indeed, culturebound beliefs color all aspects of camp, but the focus here is on those associated with health services.

Culture’s Impact on Health

What do you routinely do to keep yourself healthy? For example, how often do you bathe/shower? What do you eat, how much, and when? Do you avoid drafts? Do you strike a balance between exercise and rest?

When you get sick, what do you eat and drink? At what point are you “too sick” to go to work/school? Who makes that decision? How do you express pain — by crying, moaning, quiet withdrawal? Do kids express pain differently than adults? Does your gender or sex make a difference to these things?

These are examples of how acculturation influences health and the expression of it. Our campers and staff typically learn these expressions in their home environments, most often under the tutelage of that esteemed sage called “Mom.” Their health practic- es and beliefs come to camp with them. Negotiating their expression when feeling good and in the perceived “safe space” of camp is easy. But all it takes is for someone to get ill or injured and the personal health beliefs come roaring into play. For example, an international counselor got admitted to the health center because of flulike symptoms. The nurse brought a classic “sick person” breakfast the next morning: dry toast and some ginger ale. No way would the counselor eat that: “It’ll make me throw up!” He wanted a bowl in which there was an apple that had been grated and allowed to turn brown. That’s “sick food” in his country.

As another example, a camper came to the health center complaining of a headache. “Can I have a couple Tylenol? ” he asked. “I’ve been playing soccer all afternoon and didn’t drink much. Yeah, I’m dehydrated; I’ll get on drinking water, but I could really use those Tylenol too.”

He was followed by a second camper coming from the same afternoon of soccer and also complaining of a headache. This camper dragged himself through the health center door, draped his body over a chair, and said, “Man, my head is totally pounding. I’ve got an awful headache; I think I’m getting nauseous too. I must have headed that ball a hundred times today. I bet I have a brain tumor. Think we should call my neurologist? ” Similar activity, similar-aged campers, similar outcomes to assessment — but totally different expression of their headache status. Interestingly, the first camper was from a farm in rural North Dakota; the second boy was from downtown Chicago. Sometimes we forget that one doesn’t have to be from a different country to have a different health belief.

Care: the Heart of Camp and a Core Value for Camp Nurses

Parents value the camp staff ’s ability to care for their child. In addition, camp supervisors know that the more cared for and cared about staff feel, the better they will do their work. But care is the focus of nursing practice and a camp’s health center. Our campers and staff see physicians for diagnosis of their illness/injury; they turn to nurses for their care. Interestingly, however, care is valued by individuals only when they feel cared for. A nurse might do many things for someone, but if the person doesn’t perceive those as caring behaviors, the feeling of being cared for does not exist.

This has particular importance for camp nurses because they care for people who are away from their typical support systems. When campers and staff come to the health center with a problem, they should leave that experience feeling cared for. Putting a bandage on a bleeding cut elicits that feeling for some; others want their suffering/pain acknowledged; still others expect a “kiss-and-make-it-better” approach. It is the camp nurse’s responsibility to assess the person’s need for care and to meet that need. How? By adapting his or her nursing interventions in a way that compliments the individual’s culture-bound expectations. 

How many camp nurse performance appraisal systems evaluate for this skill? More importantly, how many health center supervisors recognize it as a critical skill and talk with health center staff about it?

Discovering Culture-bound Health Beliefs

Even when people share a culture — the North Dakota and Chicago campers were both part of U.S. culture — their expectations for health care may be very different. Differences become even more apparent when the client and nurse are from different cultures. This difference — the camp nurse with one cultural background and the campers/ staff with another — is fairly common.

Healthcare educator Geri-Ann Galanti, PhD (1991), recognized that understanding culture-bound health beliefs starts with awareness of one’s own beliefs. Applying this to our camp world, assume that your camp’s medical protocols and the nursing policies and practices used represent one culture. Even your kitchen policies, such as the span of special meal plans provided and attention to food allergies, reflect the camp’s health beliefs. The same holds true for the attention given to the camp schedule’s balance between activity and rest. All these reflect the camp’s health beliefs and values. Try auditing your camp’s health practices and policies; are you satisfied with the beliefs reflected by them?

How do we know if parents will be satisfied with what we provide? ACA Standards direct that parents be in formed about some things. For example, Standard HW-10 directs that parents be given written information as to when the camp will notify them regarding their child’s health. Camps utilize a variety different people handle things — especially health matters — in various ways. Providing opportunity for parents to share their preferences at least opens the proverbial door to conversation.

When it comes to caring for individual campers and staff, health center staff should be coached to ask the client, at an appropriate moment, if they feel cared for. The goal is to match health center staff goals with the client’s expectations. This matching of client needs and provided care preserves and complements culture-bound health beliefs. The result is what U.S. culture calls a “compliant person.” If recommended care does not meet client expectation and the nurse ignores or doesn’t recognize this, the client is likely to feel neglected, spiteful, angry, disgruntled, and/or a host of other alienating emotions. Health can be compromised as a result.

Sometimes campers and/or staff respond negatively even when the nurse has attempted to meet expectations. Consider the situation in which a girl sees the nurse because of poison ivy on her face, neck, and arms. The girl wants relief from the itching so the nurse applies calamine and gives her some Benadryl. That afternoon the nurse overhears the girl complaining to other campers. She expected the medication to cure the rash but it has gotten worse; it’s now blistering and weeping clear fluid. The girl was not told what to expect; there was a discrepancy between what she thought would happen and what actually occurred. The expectation may well be a function of the camper’s belief that effective medication is medication that cures. What the nurse thought to be a request for relief from itching was something quite different.

In this situation, follow-up would focus not only on care, but also on expectations. Perhaps there is concern for her image; poison ivy on the face can be hard to take at 13 years old. Perhaps the camper needs education about the expected course of poison ivy. Perhaps the girl really did expect the medication to cure it. These examples reflect culturally influenced beliefs. Some responses — like teaching about the poison ivy’s expected course — can result in reshaping the client’s expectations. Others — like adapting the treatment to preserve the client’s body image — require the nurse to accommodate the camper’s existing belief.

The more difficult situations are typically those that require negotiation. A difference exists between what the client wants done and what the nurse would like to do. Resolution of that difference requires the nurse to focus on true client-centered care, a concept articulated by Erickson’s Modeling and Role-modeling theory (1983). There are times when it is necessary to do (or not do) something because of client wishes. Effective negotiation results in the client feeling cared for. For example, consider a camper taking tetracycline for acne, a medication given on an empty stomach. The nurse and boy arrange their schedules to comply with that, but the boy consistently neglects to come for the medication. That means the nurse must look for him. This gets tiresome very quickly. For whatever reason, the camper has put a higher priority on something else. The nurse might talk with him to determine why the disconnect exists. Perhaps the scheduled time is in the middle of soccer and he is an avid player; perhaps the boy couldn’t care less about the medication and it really is a parent issue. Whatever the reason, the camp nurse should probe, identify the restraining factor(s), and then adapt using negotiation skills.

Negotiation doesn’t always work. Sometimes a camper may do something that, while being appropriate at home, is inappropriate at camp. Then repatterning comes into play. Take the example of a camper with diabetes. This camper has been a self-manager at home, a wonderful skill that builds the youth’s confidence and self-reliance. That ability to self-manage is important to retain, but that may need adaptation in the camp setting. Camps often require that medication be kept in the health center. To the camper used to self-managing his or her diabetes, this will feel like an imposition. Keeping supplies in the health center means not having ready access when supplies are needed and/or diverting the camper from his or her camp activity to the health center instead of simply reaching into something like a backpack to get what’s needed. The culturally attuned camp nurse will recognize the tension between at-home practices and those required at camp. Often a conversation with the camper — before camp arrival, if possible — means a strategy can be identified that works for all parties.

In summary, culture-bound health beliefs are more impactful than many camp professionals realize. Consequently, camp health services should strive to match what camp can provide with client — camper, parent, staff — expectations. This matching preserves and complements those culture-bound beliefs. If this doesn’t happen, our camp community risks not being able to serve populations we’d like to see enjoy a camp experience. Indeed, some camp practices may be off-putting to parents, but let’s make sure those associated with a basic need, appropriate health care, do not fall into this category.

References

Erickson, H.C., Tomlin, E.M., & Swain, M.A. (1983). Modeling and role-modeling. Englewood Cliffs, NJ: Prentice-Hall.

Galanti, G. (1991). Caring for patients from different cultures. Philadelphia: University of Pennsylvania Press.

Leininger, M. (Ed) (1984). Care : The essence of nursing and health. Thorofare, NJ: SLACK, Inc.

Leininger, M. (Ed) (1990). Ethical and moral dimensions of care. Detroit: Wayne State University Press.

Linda Ebner Erceg , R N, MS, PHN, is the associate director of Health & Risk Management for Concordia Language Villages and executive director of the Association of Camp Nurses in Bemidji, Minnesota.