The Classroom of Experience

Elaine Marshall would be the first to acknowledge that learning from textbooks and classrooms, while developing technical skills, are important building blocks for a successful nursing career. After all, the assistant professor in Samford University's Ida V. Moffett School of Nursing has spent her teaching career instilling those values. But Marshall also knows that an ability to relate patients is critical, too. And in the case of a community health nurse, those patients might not be your average clientele. That's why last spring, Marshall arranged for a group of graduating seniors in her community health course to spend time with some potential patients; not in a clinical setting, but in the patients' own world. A world where home is the street, regular meals are rare, and violence and abuse are a way of life. "Statistics say one out of four families will experience homelessness in a lifetime, and this population was one we had talked about in class," Marshall said. "You can talk about it all you want, but to go to where these patients are puts a whole different face on it." Over the previous year, Marshall had been in contact with downtown Birmingham's Church of the Reconciler, a multiracial United Methodist congregation known for its caring ministry to the poor. "This is a congregation that over the past 15 years has not given up on serving this population," she said. Marshall got to know some of the people the church ministers to through its four-day-a-week breakfast program. In talking with some of the homeless about their needs, she learned that many of the women were at risk for violence, abuse, and depression. And not surprisingly, they had little or no access to healthcare. As she considered ways to help, Marshall thought about how these circumstances might provide her students with some practical lessons in life. Many of them had been on mission trips and seen difficult conditions in faraway places, but Marshall wanted them to understand that some of the same needs existed in their own backyard. At the same time, Rev. Rachel Martin, assistant pastor at Church of the Reconciler, was looking for ways to connect the women in her congregation with the homeless women the church ministered to. Thus, the idea evolved to invite the homeless women in the neighborhood for some one-on-one time with other women, aided by a relaxing manicure. In addition to providing a rare moment of pleasure for the homeless women, a manicure would allow Marshall's students the opportunity to converse with the women and assess their health needs. And because the skin is part of what a nurse looks at in totally assessing a patient, giving the women manicures would serve a practical purpose in that regard, too. "I wanted to give the women a moment where they were taken out of those circumstances and at the same time, let the students be there and learn about this population," said Marshall. "We tried to make it like they were just any other women, having a conversation with another female and getting a manicure." "Nurses are always doing assessment during communication," she said. "This activity gave the students an opportunity to use the communication and assessment skills they had been taught in nursing school in a unique setting." Marshall was surprised at the response. Even though she knew word about the event had been spread around the neighborhood, more women showed up than expected. "We had women waiting," she said. In response to any health issues the women shared, referrals to health services were given, if requested. Pastor Martin and a social worker stood by to assist with any needs that fell within the scope of their services. Confidentiality was maintained throughout. "We actually referred five women from that event for mental health services and medication needs," Marshall said. By the end of the day, Pastor Martin was in tears, said Marshall. "She said we had done something in two hours that they couldn't have done in two years." As for the students, Marshall hopes they gained a better understanding of the type patient they might be serving should they choose community nursing. But she admits that the homeless women and the students weren't the only ones to benefit from the experience. "It made me a better teacher," she said.