For third-year Selkirk College nursing student Chelsey McKellar, a practice experience on the streets of her own community provided an opportunity to recognize and appreciate a side of Nelson she’d never before seen.
“It was really difficult seeing how prevalent homelessness and mental illness is in Nelson,” says McKellar. “It was a huge eye opener.”
Selkirk College nursing student Chelsey McKellar had an opportunity to learn about the vulnerable population living in her own community as part of a practical experience. Wearing plain clothes and carrying a well-stocked backpack, she met with people on the street and offered much-needed support.
The community nursing practice experience has been an integral component of Selkirk College’s Nursing Program for the last seven years. Six students spend one day a week, working in pairs with partner agencies such as Nelson CARES, Stepping Stones, ANKORS, Our Daily Bread and the Nelson Clubhouse.
Community health nursing speaks to the importance of establishing relationships, continuity of care, working with people on issues of importance to them, and viewing advocacy and involvement in public policy. These important nursing actions address the crucial social determinants of health such as inadequate housing, early childhood trauma, and poverty which predispose people to developing chronic diseases and addictions.
For McKellar, it was a rewarding experience.
“I loved it. This was by far the most impactful local practice experience through all my three years of education so far,” she says. “This has taken my blinders off as I see how many people are in need and that it’s just not the people coming in after bike crashes or with chronic diseases like diabetes. Some of these people never had a chance. We want to help them figure it out.”
Considering the Health of the Entire Community
In partnership with the existing agencies, the nursing students learn how the broader social constraints of lack of affordable housing, budget cuts that limit access to continuing education or downsizing of social services disadvantages people is directly related to high risk behaviours, and increased use of police and emergency medical services. They come to know people on the streets as individuals as they listen closely to their fears and concerns, each with a unique story of resilience, challenges and hopes. The students provide assistance that can range from information on topical health issues to basic foot care, and connecting people to appropriate services.
Students practice as part of a multidisciplinary team and serve an important function in a community that has recently recognized the need for an outreach team in downtown Nelson.
“It’s so in need,” says McKellar who had the chance to meet with Rona Park, the project lead for Nelson Street Culture Collaborative while completing her community health practice experience. “I’ve gained some serious insight in the gaps in health care and the homelessness situation here. It’s important to consider the health of our entire community.”
As part of a pilot program, an outreach team is expected to start work in Nelson this September. Two paid people will work in rotation with the next Selkirk College student nursing cohort to complete their practical experience starting mid-September.
“I appreciated being able to meet with stakeholders during their planning process. To now see the progress and how far it has come since that meeting is amazing,” says McKellar.
Lessons That Can’t Be Taught in the Classroom
Nursing program instructor Mary-Ann Morris says the students are working directly with people who are often lonely, sad, scared and overwhelmed.
“This is a very sobering rotation if you’ve never seen this side of life,” she says.
For that reason, the nursing curriculum includes content on politically rooted health equities and the social determinants of health. Included in the learning is development of competencies in community assessment and program planning that are built on partnerships and community involvement.
The nursing students leave their scrubs in the closet, wear plain clothes and don a backpack special to the program filled with items such as vitamins, toothbrushes, condoms, agency referral contact information, clean needles and mittens.
McKellar says one of the ways of connecting with people at the different sites that proved useful was to empty out the backpack, put all the supplies on the table, and invite people to help themselves to whatever they felt they needed.
“It was revealing to me how excited someone would be to have a new toothbrush,” she says. “I get to go home to my comfy bed and maybe I have two toothbrushes and I don’t even think about it. It makes you appreciate and realize we take a lot for granted. It was humbling to see how appreciative people were for those little things.”
The student nurse found the greatest challenge to the practice experience was the lack of continuity possible in the care they were able to give. In an acute care setting, patient care is continuous with follow-up provided on schedule based on a rigorous patient report. In street nursing, visits are dictated by the client, are more random and spontaneous in nature, can be cut short and follow-up is limited as the client may not be around the next week.
“You feel like maybe you are getting somewhere with a client who is facing a drug issue or has been sober for two days and you hope for the best for them, but you can’t count on being able to follow up the next day,” says McKellar. “It’s very challenging for nurses because we want to help.”
A Closer Connection to Community
The street nursing experience teaches an invaluable lesson about the delicate balance between developing trust and setting boundaries. McKellar would make connections with individuals who she would then see off-shift.
“Nelson is a very small place, and I would see people I was working with walking down the street. Of course you want to run up and talk to them but you can’t. It becomes about being able to set boundaries and wish them well from afar,” says McKellar.
Sometimes McKellar meets people needing medical attention who are reluctant to seek help from physicians in the community. They report feeling like they are considered to be drug seeking or are not taken seriously because they live on the streets. Sometimes, seeking medical care is just not a priority for them considering the challenges of their day-to-day lives.
“It’s difficult to see all the stigma and marginalization of these individuals,” she says. “It’s a matter of finding the balance between what we think these individuals need versus what they think they need. Of course we want them to go to the doctor’s office, but it’s about finding those boundaries.”
Instructor Morris sees significant growth among her students practicing on the street.
“The students find their unique voice and their role,” she says. “They gain an appreciation for the real disadvantages that mark the lives of some people, many of which are rooted in structural injustice, and which put them at risk for adopting maladaptive coping behaviours and resultant health problems. They learn that to provide effective nursing care, they need to respectfully work with individuals and also simultaneously confront health inequities at the social level, all of which instills confidence and competence that will make them a stronger health care professional after graduation.”