NUR392 PAA Written Report

NUR392
Practical Application Activity (PAA): Promoting Family
Health
WRITTEN REPORT 14 points
IDENTIFYING DATA
Students Name: Melissa Hansen
Name of local resource selected:

Margaret Cramer Free Medical Clinic

Name and credentials of person interviewed:

Becky Stover RN

Date and time visit and in-person interview conducted:

7th at 9:45 AM

Friday November

Location (at a minimum, city and state) of in-person interview:

Assembly of God Church in Des Moines, Iowa

First

Provide a short visual impression of the site visited and the person
interviewed:
This free clinic is located in the basement of a church. You enter in the back
where there is a sign that says Free Clinic Enter Here. Once entering, the
walls are painted with bright colors. The basement is also used for a daycare
and Sunday school. There are two rooms that are designated for exam
rooms only, which are locked when not in use. These two rooms look very
similar to what you would see at the doctors office, with an exam table,
cupboards and sink. There is also a room where they store medications,
vaccinations, computers, medical records, blood pressure machines and
other equipment. This room is also locked when not in use. The designated
waiting room is also used on Sundays as a classroom. The person I
interviewed openly admitted that she is 76 years old, but she doesnt even
look close to her age. On this day she was dressed in a shirt with a vest and
dress slacks. She said when she is working in the clinic she dresses in all
white nursing attire. She considers herself a retired nurse, but maintains her
Iowa nursing license to volunteer as the clinical manager for this free clinic.
RESOURCE SPECIFIC DATA
What is the purpose of this resource?
To provide medical care to people who are uninsured, underinsured, have
Medicare or Medicaid. This free clinic is open every Thursday from 6:00-8:00
PM, except holidays.

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What are some of the services provided by this resource?

Work physicals, sport physicals, well child exams, vaccinations, pregnancy
tests, pap smears, hgb a1c tests, blood sugars, blood pressures, treatment
for certain acute illnesses (examples: urinary tract infection, sinus infection,
bronchitis), and other lab tests.
Who comes to this resource for assistance, e. g., single mothers?
Anyone, at any age. Predominately people between the ages of 25-34 and
45-54.
What type of background/educational preparation/experience do the
individuals have that are involved in delivering the services
provided by this resource?
During clinic hours there is one medical doctor, usually three nurses or CMAs,
two receptionists, a couple medical students from Des Moines University and
a couple pharmacy students from Drake University. Also, the clinical
manager who is a registered nurse is there majority of the time when they
are open. Criminal background checks are completed on all volunteers
which includes checking for child and adult abuse.
How does the resource assess the people it serves, i.e., how does
the resource know that people qualify for the resources services
(see examples of working with families and assessment tools in
Kaakinen & Birenbaum, 2012, pp. 612-617)? Explain.
The data collection begins when they first meet the receptionist and
continues when interviewed by a nurse or CMA. The patients are asked to fill
out documentation about demographics and why they are needing to be
seen in the clinic. They are not asked to prove if they are uninsured,
underinsured, have Medicare or Medicaid. Free Clinics of Iowa treat
everyone.
How does the resource know if they are accomplishing their
purpose, e. g., how do they evaluate their outcomes and determine
if they should continue doing what they are doing? Some of this
information may be found on the agencys annual report. Explain.

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The clinical manager submits quarterly documentation to Free Clinics of

Iowa. This documentation is due by the 10th of month following the end of
the quarter. Demographics of the patients are entered in the computer by
the receptionists and then Becky reviews each patients chart and enters in
their diagnosis from the doctor. This information is then put into graphs for a
quarterly report.
Does this resource use emic or etic knowledge in being culturally
competent (Sanchez, 2013, p. 96)? Explain.
This free clinic uses etic knowledge, because they see multiple cultures
which are typically different from the culture of the volunteers providing
care. Etic knowledge is an outsiders viewpoint (Sanchez, 2013, p. 96).
They respect other cultures and provide medical treatment equally. Even
though this resource is provided in a Christian Church, they do not push their
religion on to the patients.
Communication is an aspect of cultural competence. What
communication strategies (Sanchez, 2013, p. 96) did you feel were
used by staff or by the person interviewed? Explain.
Becky explained that patients who do not speak English usually bring
someone with them that does. They also have a volunteer who is fluent in
Spanish and can be called if she is not at the clinic to help translate over the
phone. According to Becky the volunteers try their best with limited room
and resources to provide quality and confidential care regardless of culture. I
did not view any interactions with patients while I was there.
Identify a social or family policy by name or statute number, e.g.,
Affordable Care Act (Kaakinen & Birenbaum, 2012, pp. 619-621) that
relates to this resource? The policy can be a state or federal policy.
Explain how the policy you identified relates to the resource.
In addition to Becky submitting quarterly documentation to Free Clinics of
Iowa this documentation is also submitted to the Iowa Collaborative Safety
Net Provider Network. The mission of the Network is: Through collaboration,
innovation, and advocacy, the Iowa Collaborative Safety Net Provider
Network improves access to health services, quality of patient care and the
health of underserved patients in Iowa (Iowa Collaborative Safety Net
Provider Network, 2014, p. 3). This free clinic is providing quality care for the
underserved patients.
INTEGRATION
In your opinion, how does the resource promote the health of
families? Be specific.

NUR392 PAA Written Report

Not all of the Free Clinics of Iowa provide vaccinations, but Margaret Cramer
Free Medical Clinic does. Becky also said they do a lot of physicals, which
will sometimes diagnose a child with a heart murmur that the parent did not
know they had, or an adult with hypertension or diabetes. By getting chronic
illnesses diagnosed this will assist the patient to start managing their health.
They can also test for thyroid disease and high cholesterol.
How would you prepare a family to get the most benefit from a visit
to this resource?
All of the staff are volunteers and they may see as many as 25 patients in
one Thursday evening. I would tell the patient and family to focus on the
main reason they need to be seen. This resource is mainly for acute illnesses
and if the patient has a chronic illness they need managed, they really need
to find a primary care provider. This free clinic will still see the patient, but
cannot be responsible for managing patients chronic illnesses.

Give an example of how you could use the knowledge learned in

completing this PAA in your nursing practice.
This free clinic reminded me what nursing is really about, caring for the
patient. Sometimes we get worried about all the federal and state
regulations, meeting codes, properly documenting, that we forget to care for
the patient. The volunteers of Margaret Cramer Free Medical Clinic do
document in patients charts, but they are not worrying whether or not they
will be visited by JACHO or Medicare. The volunteers are there to provide the
best possible care they can and for no other reason than they want to help
the community. I understand policies and regulations are put into practice
for a reason, but after visiting this free clinic I realize I need to care for my
patients first and worry about the policies and regulations second.

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References
Iowa Collaborative Safety Net Provider Network. (2014). Calendar year 2013
data report. Key data about who receives services in Iowas safety net.
Retrieved from
http://c.ymcdn.com/sites/www.iowapca.org/resource/resmgr/Safety_Net/CY20
13_
Data_Report_Final.pdf
Kaakinen, J. R., & Birenbaum, L. K. (2012). Family development and family nursing
assessment. In M. Stanhope & J. Lancaster (Eds.) Public health nursing: Populationcentered health care in the community (8th ed., pp. 599-623). St. Louis, Mo: Mosby
Elsevier.

Sanchez, M. S. (2013) Cultural considerations. In J. A. Maville & C. G. Huerta (Eds.). Health

promotion in nursing (3rd ed., pp. 90-106). Clifton Park, NY: Thomson Delmar
Learning.

10/13, rev. 10/14 nr