Home Visits in Rural Nicaragua: A Transcultural Primary Care Experience

Abstract

The focus of the health care delivery system in the United States has shifted from an emphasis on acute care delivery and hospital-based care settings to disease prevention and modification of lifestyle. More nurses are focusing on primary care and health promotion. The nurse practitioner (NP) role was developed in response to an increased need for access to primary care. NPs integrate clinical knowledge with the knowledge of community resources. With the development of multicultural communities and the increase in the diversity of our population, health professionals need to develop more cultural sensitivity. What better way to understand the needs of clients and the culture from which they come than to assess them in their natural environment? This article will describe a family NP clinical practicum in the rural mountainous region of Nicaragua and how home visits were used as an integral part of the NP transcultural primary care experience.

The Community Health Fair as an International Health Promotion and Disease Prevention Strategy

“…The average family size is about eight members. The annual income in the area, as in all of Nicaragua, is about $300 to $600 per year (Leonardo, Checco, & Coggins, 2001). Many families live below the poverty level.…”

“…The Roberto Clemente Clinic and a local two-room school share a compound in the rugged mountains of Nicaragua. The Roberto Clemente Clinic provides health care for seven communities or approximately 3,000 people in La Reforma (Leonardo, Checco, & Coggins, 2001). The clinic is a one-story block building with a tin roof and a large covered front porch that serves as a waiting area for clients.…”

“…The kitchen consists of a clay or stone stove located in a corner of the room, a shelf or two for utensils, and sometimes a small wooden table. In most of the homes, the stoves are vented directly into the dwelling, filling the rooms with smoke during cooking (Leonardo, Checco, & Coggins, 2001).…”

“…Some of the homes have an outhouse or latrine, a wooden structure situated 35 to 40 feet away from the house, but many homes only have an open pit or a designated area and others have no allocated area. Those without specifically designated areas for waste are at the greatest risk for disease (Leonardo, Checco, & Coggins, 2001).…”

“…The second project was anemia screening for high-risk children because of lifestyle and nutrition issues. The third project was a health fair consistent with Nicaraguan Health Ministry's move to a participative health promotion focus (Leonardo, Checco, & Coggins, 2001).…”