The Role of Public Health Nurses

Summary

Highlights

• Melissa Sarahina and Cherry Kukona share their journeys to becoming public health nurses, highlighting their passion for community work 🌺.
• They describe a typical day working with various community programs, emphasizing adaptability and accessibility 🚑.
• The crucial role of building and maintaining relationships in public health nursing is compared to real estate—it's all about connections! 💼.
• Public health nurses are there not only to treat but to educate and empower clients to care for themselves 🌟.
• Discussing initiatives like the Kapalama Toolkit, aimed at enhancing health literacy and wellness in the community 📖.
• Emphasizing the holistic approach of public health nurses in addressing comprehensive health needs and facilitating connections to care 🧩.
• A heartwarming example of helping a family adjust to life with an autistic child illustrates the deep impact of patient education and support 💖.
• They talk about the satisfaction and challenges of working with underserved communities, demonstrating a deep commitment to their roles 🙌.
• Public health nurses act as vital liaisons between the community and healthcare services, helping to bridge the gap in healthcare accessibility 🌉.

Key Takeaways

• Public health nurses are the heart of community health, focusing on relationships, prevention, and education 🏥.
• They work directly in the community, building lasting relationships with clients and connecting them with necessary resources 🌍.
• Public health nurses play a crucial role in improving health literacy and access to healthcare for vulnerable populations, such as the houseless 📚.
• The role of public health nurses is diverse, requiring them to wear many hats, including that of an advocate, educator, and even a counselor 🎓.
• The collaboration between public health nurses and community programs is essential for the creation and implementation of effective health and wellness initiatives 🤝.

Overview

Chapters

• 00:00 - 00:30: Introduction The chapter begins with a live session where participants seem surprised at how quickly time has passed; it's already Tuesday. The focus for the day revolves around Hawaii's state of health, featuring individuals from the state health department.
• 00:30 - 05:00: Role and Responsibilities of Public Health Nurses This chapter focuses on the role and responsibilities of public health nurses within the department of health and the community. The show aims to provide an updated snapshot of this dynamic field, acknowledging the constant changes in the roles of public health nurses. The discussion begins with Melissa and Sarah introducing Hina, a public health nurse, highlighting the special designation that accompanies this role.
• 05:00 - 15:00: Community Engagement and Relationship Building The chapter titled 'Community Engagement and Relationship Building' begins with a conversation at the Hawaii Department of Health located at the Waipahu Civic Center. The interaction includes individuals named Sherry and Kukona discussing identification and vouching for one another. Sherry shares her journey of becoming a public health nurse, mentioning her education in nursing school in Hawaii, suggesting a discussion focused on professional roles and their paths within the community health framework.
• 15:00 - 25:00: Programs and Collaborations The chapter focuses on the various nursing programs and specialties available at the University of Manoa. It highlights different classes such as community health nursing, medical-surgical nursing, pediatrics, and psychiatric nursing. Each semester, students enter one of these specialized programs, with community health nursing being particularly appealing to some, as noted in the transcript.
• 25:00 - 45:00: Challenges and Experiences The chapter titled "Challenges and Experiences" describes the narrator's journey and preferences in their work life. They initially worked in the hospital and enjoyed their rotations but realized that their true calling was working in the community, directly with children and elders. The narrator finds fulfillment in primary prevention rather than hospital work, indicating a preference for proactive rather than reactive approaches to health and well-being.
• 45:00 - 57:00: The Impact of Public Health Nurses This chapter explores the role and impact of public health nurses in community settings. Unlike hospital environments where patient interactions are brief, public health nurses engage with patients more deeply by visiting their homes, thus fostering long-term relationships. By educating individuals in their own environments, these nurses aim to prevent health issues and promote well-being on a community level.
• 57:00 - 78:00: Case Studies and Personal Experiences The chapter titled 'Case Studies and Personal Experiences' revolves around the role of a service provider or case worker who connects clients with needed services. They assess the services required by their clients and link them with appropriate agencies for support. The narrative highlights the importance of understanding available services and building a relationship with clients. Often, they act as a listener or 'sounding board' for their clients, emphasizing relationship development and ongoing client support.

The Role of Public Health Nurses Transcription

• 00:00 - 00:30 okay we're back we're live you know it's my god what what day is it already it's tuesday yeah and that means it's hawaii the state of health okay with the state health department you guys are here from the state health department
• 00:30 - 01:00 we're calling this show the role of public health nurses in the department of health and the community i've always wanted to know about this stuff but the problem is it's changing all the time so today we'll get a snapshot of what's happening melissa sarah hina uh public health nurse that's a special designation yes it is probably have a name tag somewhere that says that i do i have a name tag right here can i borrow this well let's just start sarah here registered nurse and state of
• 01:00 - 01:30 hawaii department of health yes and you're in waipahu civic center yes that's your base for operation that is my basic conversation oh too bad that's a sherry a kukona she doesn't have her badge it's in my bag i'll vouch for her she's okay all right we'll take that so sherry tell us how you got to be a public health nurse oh okay well you know i i entered nursing school here in hawaii yes
• 01:30 - 02:00 university of manoa yes and uh mary bowland yes yes yes and uh you know we go through all the different um the different programs in nursing so different classes we have community health nursing we have medical surgical nursing and then we have pediatrics psychiatric nurses all these are different kind of nurse specialties yes so every semester we um we enter one of those programs and of all those programs community health is what jumped out at me this is what i thought this is what i wanted to
• 02:00 - 02:30 do i went to work in the community working with children with elders you know i enjoyed my rotations in the hospital but that's not really that wasn't me i wanted to be out in the community working directly with people um because i was i've always the concept of primary prevention is always what i um liked having to work in the hospital and um getting medications and all of that that was that was a good experience but um it was more important to me to be
• 02:30 - 03:00 out in the community educating people and hopefully preventing them from people-oriented parts yeah yeah yeah yeah so um but it's also it's more than that it's when you're in the hospital the patient comes in you see him for a couple of days he leaves yes the community it's not like that no it's not i mean you go into the homes and then you you basically build a relationship with them and uh you know you find out what's going on
• 03:00 - 03:30 what kind of services do they need you hook them up with whatever services they need because we know what agencies are out there what services those agencies provide and we hook them up with the appropriate services and hopefully they can get um get the services that they need and uh we we're just there basically sometimes we're just a sounding board um people need us it comes right yeah and so we really we develop relationships with our clients
• 03:30 - 04:00 um now they say when i was practicing law you know real estate is not about land it's about relationships yes it is you can all you can also apply that to many other things including public health it's not so much about health as it's about relationships put them in touch hook them up yeah yeah that's great so and is was it like you thought it would be um it was slightly different when i was
• 04:00 - 04:30 in school um the public health nursing rotation that i went through even back then like eight years ago public health nursing was pretty different wasn't it um not too different but uh i guess in my rotation we did a lot of school health and home visits as well and that is still what we do but i guess what i didn't see when i was in school was all the community work that public health nurses do and it's a lot of community work working with different
• 04:30 - 05:00 agencies developing um health and wellness programs um we have a few examples we can talk about later yeah so but it's uh all been very great experiences i actually come to work and i don't um hyperventilate before i used to work in a cardiac unit and some days i would have to start in my car and i'd stay in my car and hyper runway before starting my shift but i come to work and i'm all smiles and um yeah yeah well that's great that's what you
• 05:00 - 05:30 went to nursing school for wanted to help people that's right looking at the community okay melissa you know so now now it's your turn sure you you decided at some point this is what you wanted to do what were the factors to that decision well you know i had an opportunity to actually do my nursing at the leeward office the leeward phn office when i was in school and so in doing that i i really found my niche working with people making that
• 05:30 - 06:00 connection like cherry said working with the different programs and every day is a different day you never know what's going to come to your desk you just got to be ready to go and think on your feet it's different than a doctor i think a doctor my observation i'm just an ordinary patient person but a doctor is surrounded with formality with staff and paperwork and it's not only you walk in and say hi i can't do that no no doctor unless he's
• 06:00 - 06:30 your uncle or your brother or something but um with a nurse you're much more accessible yeah and i mean that's probably good and bad but for you i think it's probably good because you want that you know you want them you want that connection they you want them to to have a connection correct and you want to to give give them that access where they can come and find you any time and you can help them any time and you're available to help them right right as nurses we're able to adapt to the needs of the community
• 06:30 - 07:00 yeah yes you're not saying the doctors don't adapt no no well i'm not saying that we're talking about nurses okay okay so what is it like in a given day what do you do oh a given day so uh you don't hyperventilate at all no no there's times where you do well um like cherry said uh we actually work with um different programs we work with the doe schools so
• 07:00 - 07:30 a day could look like you have to go out and maybe do some emergency action plans at the school train the teachers on a specific condition for example like asthma then another thing you could be collaborating with a program and working on a health and wellness piece to be included um yeah so it can it can be a a very busy day yeah yes so how far you go in the
• 07:30 - 08:00 in the direction of practicing medicine i mean i for example i was telling you i got this call from hmsa which i really appreciated a lot when they say you know we're we're part of the health and wellness program which sounds like a new concept i don't think this was around 10 years ago um and we we we want to have contact with you between your your appointments at the doctor and so we want you to call us and we'll call you and while this regular communication and if you have a problem you'll tell us and
• 08:00 - 08:30 we'll give you some advice about where to go what to do and uh you know that's remarkable this never existed before and i don't know about you but i've noticed that as i said before doctors are less accessible in the last several you know decades and now so this fills the gap i think you guys are part of the same thing filling the gap and for a wellness for lots of reasons am i right yes yeah yes so what is a health and wellness program at least as far as your
• 08:30 - 09:00 concern what is the health and wellness program yeah cherry used that term to start so um actually we do work with different providers in the community so for example we are working with the kapaalana traveling preschool and they actually provide educational services to the houseless population and that risk so houseless yes homeless houseless
• 09:00 - 09:30 got it yes the houseless population and basically we have been collaborating with them to see how we can create a health and wellness program particularly for their staff as well as their participants so we collaborated together and developed what we called the the kapalama toolkit and basically that included very basic
• 09:30 - 10:00 health information that anyone can use and uh we were looking at targeting health literacy right and and wellness into their program it's funny a lot of people don't really know about health i'm not sure why do you know why and we find people who are perfectly educated sentient people but they seem to have missed out on being educated about their own health well there's a difference between having
• 10:00 - 10:30 functional literacy and being able to read there's health literacy and basically being able to read that health information understand it and make the appropriate decisions for your health stakes are high yes so you help them with that yes you give them the materials you ask them to read the materials and you ask them if they have any questions and then you come back later and ask them again if they have any questions well the
• 10:30 - 11:00 thing is when it when it comes to working with our families in our communities we want to make sure when we're going in that we we truly know their health literacy level right we understand okay so maybe they have english as a second language um maybe they can't read they don't have functional reading educational level maybe they graduated or they didn't they only went up to the eighth grade so you really
• 11:00 - 11:30 have to look at how they learn and so when you go in you might take pictures right versus something written right or a video so they're able to understand wow this is you got to be a psychologist and a sociologist too we wear we wear many hats yes we do so okay so then you say you know i was joking before but i have this i have this pain right here okay we're doing a case study now okay i have
• 11:30 - 12:00 this pain right here what do i do what do you do uh well we just do our nursing assessment first um how long have you had that pain what happened and what happened see how did you get it somebody punch you baby okay yeah so we try to just ask you know what happens um what kind of pain is this a sharp pain is it dull does it come and go is it constant
• 12:00 - 12:30 rate right and um you know have you seen your doctor then um and then at that point you don't you you don't have a doctor you haven't seen your doctor do you have health insurance that's really good all those good questions yeah i mean we don't know exactly what answers you're gonna get yeah so we really truly have to do a a comprehensive assessment to see what what what that individual needs yeah
• 12:30 - 13:00 right yeah yeah okay and so um you might but you you know you might find for example this is something obvious uh maybe it's black and blue and somebody hit him in the face yesterday who knows what right um and you can make sort of a you know a putative type diagnosis what what do you do then i mean so you may or may not know but you think it might be this and that what do you do you refer to a doctor do you treat do you treat do you give them bandages
• 13:00 - 13:30 well if they they would need a bandage but we would recommend again we'll do the assessment and from there we would decide okay hey what next steps are we going to take are you going to see your physician should we call and hey let me talk to the the nurse or the doctor hey this is we're with so and so this is what we see where do we go from here advocate to that correct oh you're gonna be getting an advocate too yes okay so we just still yeah we need to look at
• 13:30 - 14:00 everything as public health nurses we do we look at everything comprehensively to ensure our clients the community they get what they need filling in those gaps like you said so you palpate his face and it feels like the bone is broken right there and you send him down to a doctor or maybe an emergency room depending on okay now now he you know they do something i don't know what you do but they do something okay he got treatment okay something and um now he's he's back he's back a few days
• 14:00 - 14:30 later right did you get to see him again yes how has he done it yeah so you want to make sure that if there was any type of surgery or any type of treatment recommendation that was given to him or him or her that you want to make sure you go through it with them what do you need to do how do you need to take that medication how do you need to apply that ointment right what is it used for so it's really making sure they understand what they need to do to
• 14:30 - 15:00 care for themselves this is a mitzvah you know mitzvah it's yiddish it's a blessing it's a good deed yes public health nurses yes because otherwise he wouldn't know right otherwise the chances are as good that he'll make a mistake and make it worse or not make not get better soon enough and all that and then hopefully in the future they're able to care for themselves right because you're building on that you're building their their education and understanding of their condition yeah are you going to see him in your
• 15:00 - 15:30 office or at his place no at his place really yes place of work place a residence piece of residence or wherever they feel comfortable you go you have an appointment with him you're going to follow up with him yes he's on your calendar correct you're gonna go find out what happened to the guy yes all right we're gonna go find out what happened to a break we're gonna take a little break here we're here in hawaii if you didn't know the state of health uh and we're talking about the role of public health nurses in the department of health and the community with melissa sarahina and cherry kukona
• 15:30 - 16:00 and we're having such an educational experience i'm feeling better every minute okay we'll be right back aloha my name is josh green i'm a senator from the big island i work in the er there but on tuesday afternoons i get to come and spend 45 minutes to an hour with jay feidel and the think tech staff they're terrific professionals they help us to bring some of the leading cutting edge topics here across our state to you so you can join us at our show on healthcare in hawaii to talk with leaders from across all the spectrum of health
• 16:00 - 16:30 in our state or you can join us for any other show where we talk about economic development or tourism or some really eclectic programs too so really we'd love to see you here on our show thanks for joining us and thanks for supporting us aloha my name is miley scarpino and i'm the host of the empower hour if you're interested in health nutrition fitness here on the island of oahu want to learn more about places to train at or different trainers available
• 16:30 - 17:00 then watch my show on fridays at 3. we have a great time and i hope that you'll come join us much aloha now go get swole right but it's okay okay we're gonna go back now we are back oh how come you didn't tell me oh no i didn't know i'm back okay i'm jay feidel this is think tech and we're talking about community matters because community does matter and i'm talking about the role of public health nurses in the department of health and the community here in hawaii the state of health okay
• 17:00 - 17:30 and melissa sarahina at my left and to her left cherry cucuna both public health nurses um and they both have credentials to show so you mentioned you both mentioned at some point of discussion about the houseless and the homeless big problem you know and every time i i see in the paper you know that they're of 4937 homeless i say how do they know that is there any way to know that and how about the people that got to be homeless in the last 20 minutes
• 17:30 - 18:00 how do they know that you guys are on a cutting edge with that and trying to help them have reasonable lives in their condition but first you know you had an interesting um philosophical distinction between homeless and houseless and i'd like you to tell us about that okay you did too jerry so we were sharing with jay about um
• 18:00 - 18:30 the terminology the difference between homeless and and houseless so when when you say houseless someone the individual or family basically doesn't have shelter over over their head or a house when you say homeless it it comes from the heart people really look at home as a place of love as a place of peace so you can have that without having a
• 18:30 - 19:00 house yes yeah and you had an interesting twist on it about the hawaiian people yes we feel they're at home right wherever they are yes because this is this is home this is what you know hawaiian land yeah and so um you can't you know to just stay homeless they are home this is home right and uh so they are not homeless they're just houseless yes without shelter for me for myself i believe that we're not doing enough for them that we have to do much much
• 19:00 - 19:30 more and if we don't do it it's a shame on us so the question i mean the point that i would make just gathering from this conversation is that this is one way where the state of hawaii is actually doing something hands-on you're going out there affirmatively so tell me how it works how do you how do you go where do you go what do you do to to deal with to treat with to give comfort to the homeless houseless how does it work go out on tuesdays um
• 19:30 - 20:00 no that's not so much like that but like uh melissa mentioned earlier kappa alana we work with them a lot and so it's partnering with agencies that are already out there and providing um supporting them and providing them with that help whatev if the program doesn't have a health component we we help to provide that health component to their program and then we do have individual cases we
• 20:00 - 20:30 might have a referral from someone or some of our nurses do case finding within these populations and so we'll find cases there and then we'll and that in those cases we'll do one-on-one or um we'll take on a family as a case to follow so now you have a file essentially on this family you have some concern about the health of this family and you can go back and talk to them again and again make sure that they're okay and that they're getting
• 20:30 - 21:00 reasonable health care is that what it is yeah you're gonna meet them where they're at so for example you know i have i've had families that lived on the beach and basically i would do my home visits there but eventually getting them connected to the emergency shelter and then eventually to transitional and then low-income housing they're friendly with you they accept you they appreciate you yeah maybe more than they do others well because you want to build a trusting relationship yeah yeah like we said relationships are so
• 21:00 - 21:30 important so um they probably have a series of ailments that come from being houseless because they're outdoors all the time i don't know what that would be but i imagine there's a subset of things that happen to them and you you have some idea going in that you know that might be the case what kinds of things do you find well first when we go in of course like cherry said we want to do that
• 21:30 - 22:00 assessment so what are the needs at this moment for this family and that at that point we start connecting them to the resources that they need and then hopefully once we we get everything together and we've worked with the family and they've actually are engaged with trying to have that better lifestyle so um it does take time and
• 22:00 - 22:30 you just you just gotta go with where the family is at that's really remarkable and you know where they are i mean yeah you know where your clients are right you want to know their story yeah yeah it's all about that yeah story truly so you get you you get to know them they become more than strangers yes and and i mean this could last for years now yes you can know them as the kids grow up you can know them through the thick and thin right and then you can
• 22:30 - 23:00 know their kids and the generations and you can keep them i would say keep them alive but you could keep them balanced keep them relatively healthy yeah what's the interconnection the intersection between that and uh and health insurance and all that when you find somebody homeless presumably have no money uh so how how how do they get health insurance if if at all um and how do you get them treated if
• 23:00 - 23:30 they don't have health insurance what is it always an emergency room thing or what no it's not an emergency room thing so what we do try to do is if they don't have insurance we try to get them signed up we have this great program right now we're connected with the pacific gateway center and they are actually one of the healthcare connector programs under the obamacare correct so um they actually come to our offices and they
• 23:30 - 24:00 provide that service on getting people signed up signed up for medical insurance so yes so we try to do that and then at that point once they do get connected and then they do need to choose a physician at that point we get them connected to their physician and hopefully once they do that they can build that relationship with that medical home so we truly look at getting everyone connected to a medical home
• 24:00 - 24:30 right so and then they deal directly with the medical homeowner correct correct well they'll deal directly with the medical home but they'll we'll help them with that transition because sometimes we may need to go with them to their appointments because they may not understand what's going on maybe it's not beyond the call for you guys but it's going a long way if you truly know the needs of your family or the community you're gonna do what needs to be done so you may need to go with them make sure that they get connected make sure again they understand what
• 24:30 - 25:00 they need to do to take care of themselves yeah so you're truly really building that individual that family in that community yeah well so do you ever actually you know take blood pressure and uh inspect people in the eye in the ear and open your mouth with a little wooden stick that guy you do that too yeah but when do you do that if you're if we have a um a client we can do that our assessment in the home or we do it on a larger scale for screening is this so is this a special category of
• 25:00 - 25:30 nursing that's provided for in the law is that what it is i mean how but where are you seen are you the same as a registered you are yes you read mine yes yeah yes so it's all the same or is it different okay well um yes we're passing the tough ones no i mean we are you know um we're all licensed registered nurses so there's just different fields of nursing
• 25:30 - 26:00 so you have the acute care nurses who work in the hospital um you know and even then there's different types of nursing right there's pediatric nurses there's maternity nurses er nurses um and then you have the home health nurses oh that's the kind of come when you're yeah we're getting old right they are not necessarily old but if you need um skilled nursing services at home right they come and visit you and they provide services there and then you have you know nurses who work in doctor's offices um but we then there's department of health
• 26:00 - 26:30 nurses public health nurses but so all different types of nursing all different specialties um but we all have a registered nurse license and follow the same nursing process it's just that we apply that nursing process differently depending on the population we're serving in the setting in which we provide the service you have more freedom don't you have more discretion you're out there on your own right yes there's a lot of independence
• 26:30 - 27:00 so who you want to see well we don't decide who we want to see well we do our nursing assessment to determine the needs of the client yeah yes so from what what what cherry was saying is um yeah you have all different types of nursing but public health nurses truly look at the health of the public across the lifespan oh yes it's across the lifespan so you there's infants school age you're elderly
• 27:00 - 27:30 so yeah so that means so it's a general practitioner and we're we're bonded then yeah yeah for life right now it's gonna be longer for you than me for life okay so but if you run into somebody in your travels then that person is somebody that you can or maybe should or will follow and check it out like the woman who called me from hmsa she wants to know every week
• 27:30 - 28:00 how i'm doing right you know it's a great way to do wellness because then people don't fall off the side so quick and they can identify things at that moment right and what's going on in your life any type of you know maybe you're feeling depressed or or you know i was going to ask you about that i mean if you're dealing with people who don't have regular doctors who don't have houses sometimes um you probably find a lot of people who are depressed
• 28:00 - 28:30 and who maybe have you know a serious mental illness sometimes how do you handle that because that's that's something you wouldn't see if you were practicing in an ordinary you know doctor's office or hospital setting you wouldn't see that nearly as much right right um and we do encounter those situations and train for it i mean yeah sometimes it's hard to know yeah and it's sometimes that you you might be in situations where you need to de-escalate be calm and um i know you're being calm
• 28:30 - 29:00 now yes yeah but and really understanding how to handle yourself as a nurse in those situations yes so um then you have to talk them down yes this this could be a whole street scene actually yeah you could be the one yeah be the one at the frontier so to speak you could be anywhere that's the thing about public health right you represent the state actually in in the community in all
• 29:00 - 29:30 parts of the community we're an expansion of the department of health yeah and yeah and you bring health to people that the ordinary health establishment does not reach so that must give you a certain level of gratification does it pay well would you be making more money in the in the regular medical community you know i think it would depend it just yeah it depends but we're just happy with what we do that's right you do it you do it you do it
• 29:30 - 30:00 yeah you you do it for the love of public health nursing yeah okay for sure when we come back i want to talk about not not love but a kind of love i want to talk about organizations okay of public health nurses and how you get to see your your peers and colleagues okay and um and how you you know sort of come together within the organization okay okay um we're going to take a short break i'm jay fardio this is hawaii the state of the state of health i'm talking about the role of public health nurses in the
• 30:00 - 30:30 department of health and the community with melissa sarahina and cherry cucona both public health nurses we'll be right back hi i'm ethan allen i host likable science on think tech hawaii and i do this because i care about science literacy in hawaii i want to spread the understanding the science a vital and interesting part of everyone's life i want to make sure the broadest possible spectrum of people understand the beauty and the value of
• 30:30 - 31:00 science and realize that science plays out each and every day of their lives i want you to understand that science is fun so we bring onto this show each week guests who are scientists from astronomers to zoologists and we talk about what they do and how they do it but most importantly we talk about why you should care about their work why you should see that their work has value and impact on your life so i hope you'll join us fridays 1pm here on think tech hawaii you can watch
• 31:00 - 31:30 us via live stream you can watch us uh recorded on olelo and you can see us uh each week we hope you'll join us okay we're back we're live we're in the last segment of our show on the role of public health nurses in the department of health and the community here in hawaii the state of health with melissa sarahina public health nurse and terry cucona public health nurse so uh yeah i just wanted to sort of get the larger landscape the group in
• 31:30 - 32:00 general public health nurses the force if you will right okay you say there are a hundred statewide all islands or most islands i guess have 11 ph in offices statewide okay what's a phn office like what's in it is it is it got an opera operating room no no it doesn't um basically um it does have uh clinic rooms because in the past public health nurses
• 32:00 - 32:30 would do uh screenings they would do the um they would actually help the physicians in doing physical examinations yeah are there public health doctors too no public health doctors you know the the doctors that you would be screening for i mean that kind of thing well that was back in the past that was back in the day i remember i was in the federal government yeah that was back in the past public health service yeah federal
• 32:30 - 33:00 public health service right uh but you don't have that yeah no because now we have med quests right and then now we we recommend going to a medical home where you can get all your your needs met then yeah so you are the front line yes yeah okay so 100 statewide and um in each office there's what two three five something like that depends um you have offices that have about 15 nurses and then you do have some
• 33:00 - 33:30 offices that have about six or eight nurses depending okay yeah so uh you know where where is it going do you think i mean one thing i will offer my reaction is that it's going more to you i told you this before it's going more to you guys you are the front line you offer medical care to people who might not otherwise have access to medical care um you are more like doctors every day but that's the way the whole medical profession is working it really is i mean it's not no secret
• 33:30 - 34:00 there and um you know where do you think it's going from here uh you've both been with the organization for a while you know you can see the sea change what is the sea change well i think now it is going back to community where it started off at uh old hawaii style yes community and um at one point it did focus more on that hospital the hospital type
• 34:00 - 34:30 nursing but now it's definitely going back to community because that's what you're talking about going out to see people and engaging with them in their place well yeah so the voice of the community and community involvement is just so crucial because that's how you sustain communities yeah and their health and their wellness yeah but as you know it's more than that is you're you are the state government you are reaching out you are making a message to people that
• 34:30 - 35:00 the state cares about them yes and wants them to be well and uh that's a huge message you're the voice of the people you are and you may be you know think about it who else in in in the state and the fed actually does that hello i'm i'm your friendly public health nurse and i'm here to help you wow i'm from the government i'm here to help you and you really mean it right right yeah well that's that's a good thing for
• 35:00 - 35:30 hawaii this is a this is a great program right yeah so i wanted to i wanted to ask you also about how how this affects people on the other side do they appreciate this what we're talking about i mean you say community and that kind of assumes that they do but how do they feel about you do they send you flowers at christmas you know we have a good relationship with our communities with our providers also with the different uh federally
• 35:30 - 36:00 funded clinics yeah so we do and um i believe they do appreciate what we do yeah as being the link yeah well that's true yeah to the community so what about what about uh as i mentioned before what about getting together with other members of the public health nurse force you get you have a you know a training program or a program in which you all get together and compare notes on what's what's out there how's that work if at all
• 36:00 - 36:30 well um we do have a chance to to meet annually to see what's going on with the other sections and the other neighbor islands also we stay connected with the different groups that we have we have an elderly group breastfeeding group and so forth so that's how we truly stay connected and what's going on you have resources i mean for example you run into this fellow with a
• 36:30 - 37:00 problem in his face uh i don't know what to do about this can you email or call someone and get some advice about that how does that work well in that particular case we would most likely just refer him to see a doctor to see a doctor maybe um you know one of the clinics federally funded clinics if he doesn't have health insurance um yeah but for other situations like you know if there's a
• 37:00 - 37:30 breastfeeding mother who needs resources you might refer her to wic or um other breastfeeding agencies are um yeah or for an elder so like you make a call on where they should whether you guessed it we helped to connect them right you know a few years ago hmsa this is reminiscent hmsa started a program online i don't know if this is something that you know your constituency can't afford
• 37:30 - 38:00 i mean to have a computer but there was a program online and some guys from out of town developed this program and the idea would be is you would go to you go to a doctor not your doctor necessarily it could be but not necessarily and you'd say you know i'm feeling a funny pain in my face whatever it was and the doctor would be there you'd see him with videos i'm like the doctor and you would ask him questions and he would come back to you and he could he would go only so far though because after a time he would say look i i can't feel the face
• 38:00 - 38:30 myself so you're gonna have to go see something you can feel the face right um but but uh it it's it that went away that went away then hmsa doesn't do that anymore as far as i know so the question is is there room for that in what you do do you see that in the future about where you know you can be in your office and somebody can contact you and have this conversation i know it's not the same level of relationship yeah but
• 38:30 - 39:00 have this conversation online maybe it's not part of the deal that you're the the ethic you know the the style of the right style of nursing for sure you guys are really hands-on right we're really out there in the community so i mean good idea but it didn't work the last year yeah i think it would it would take away from yeah that building relationships that connection right and that's one of the biggest um parts of what we do
• 39:00 - 39:30 is is having that relationship with the family because um you know you can only do so much um you know you can tell somebody to do something but if you don't have that relationship with them to understand why they haven't been doing what they were told to do then going back and telling them right going back to tell them and telling them the same thing you know they're not going to do it still so you need to go and find out what's going on what's what are the barriers and then work with them to overcome
• 39:30 - 40:00 those barriers so that they do um follow through with their treatment plan so it's trust yeah yeah they gotta trust you you gotta trust them right i tell you right it is that root cause what is truly happening you know that's like what they call it design thinking you know what design design thinking is problem solving in general you probably have it in the nursing industry just as well and what the guy presents to you you you never accept that per se because
• 40:00 - 40:30 you always have to be satisfied that it isn't that or that or that you have to you sort of ask what as you just said you have to ask what it really is and only then can you get about solving it you have to be because sometimes people can't tell you they don't don't tell you and you have to unzip them and make them tell you that's right so maybe that's a big thing for you guys because you're dealing with a population that may not be willing to tell you
• 40:30 - 41:00 do you ever reach you know active resistance whether where the patient says i'm not going to tell you i you know i who are you anyway um i'm not i'm not gonna you know right i've had i've had resistance but it was just taking the time and being there and being consistent whatever is happening around them the phn is consistent they're always there demonstrating your you know willingness
• 41:00 - 41:30 to care and help no matter what yeah i mean does the resistance ever get physical no i i've never experienced anything physical they know what it is but at the end once you build that relationship they don't want you to go right they're like oh are we done yeah yeah you're doing what you need to do you're taking care of yourself you're taking care of your family so it's now it's time to move on do they do they want you to see their friends and neighbors
• 41:30 - 42:00 i mean um if if they like what happened do they refer you to someone else and then you get a call from someone else sometimes they do i mean i had a i had a gentleman a client and then he's like what about my wife so i ended up taking her as a client as well right right but um there does need to be i mean when we take on cases they're ha they have to um they do need to have a medical need to have a public health nurse so we can't unfortunately we can't take on every single case
• 42:00 - 42:30 but um you know so when you say medical need you mean they're sick in some way yes yes so you have to that's the first parameter you can't just for for for um carried cases yes for working for carrying cases cases that we follow in general you know with all the community projects it's anyone and everyone but for cases that we actually follow um there are some parameters as to who we can take on as a case you know it strikes me also that because you are at
• 42:30 - 43:00 the front end and talking to people and you know figuring out what what the condition of the community is health-wise that you your you have valuable data there you know and that through you there could be an examination of how we're doing here in the state you know demographics surveys and you can do any of that or you have any programs that are running along those lines we do that everything we do we want to make sure
• 43:00 - 43:30 that we're we're collecting data to see what our impact is on the community so we want to make sure when we do something we want it to be sustained sure right you just want to do something just shape it for the future make it more efficient right yes so yes data is very important so you're feeding it back somebody is presumably doing stats on it um and then you you learn by the success and i suppose the unsuccess too um
• 43:30 - 44:00 so in a minute we have left uh can you tell me about a case that sticks in your mind that you really liked no names okay so a case all right so um when i actually first started that was ten years ago um i was actually i had an opportunity to work with a family that um had an autistic child
• 44:00 - 44:30 and so at first the family couldn't accept it they're like why is this happening why why is it happening to my family what's happening to my my my particular child why are they different so we truly had to go through the process of understanding accepting educating and getting that family to a point where they were able to understand navigate how to care for
• 44:30 - 45:00 their child how to get them through the day what that day would look like it's not easy it's not easy because they require routine they require you to truly pay attention and and getting them through whatever they that day or or whatever they're going through so basically um at that point the family was able to become very independent
• 45:00 - 45:30 and actually now i just found out that they're they are now advocates for for autistic kids so as you can see that level of learning understanding really built yet really built that family to a point where now they're advocating for other kids so really sustaining that in the community yeah this but this uh does bring to mind the notion that in every family where there's
• 45:30 - 46:00 caregiving involved you have to train the caregiver that's right because caregiving is not easy and it requires huge sacrifice as to the rest of the life of the caregiver you know i know people who you know have had fabulous careers and at some point their spouse fell off somehow and then they made a decision i don't know if you see this often they made a decision that they were going to dedicate the rest of their lives to be caregivers happens it happens and there's you know no alternative
• 46:00 - 46:30 and they accept that so have you had um have you had an experience you want to forget one that didn't work out so well no actually you guys love your work yeah there are um always little hiccups here and there but nothing ever so so bad okay well i i suggest you keep on doing it then yes all right that's so melissa sarah hina and cherry coconut public health nurses both
• 46:30 - 47:00 totally dedicated it's wonderful to have you working the community this way it makes a better place for all of us and this is the role of public health nurses in the department of health and the community here on hawaii the state of health thank you very much ladies thank you
• 47:00 - 47:30 do
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