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  1. Pagels, Jamie Lynn MSN, RN

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The Grand Traverse Bay area of Northern Michigan is nestled between breathtaking Lake Michigan and the majestic Sleeping Bear Sand Dunes. Historic lighthouses jut out from natural peninsulas, and grand homes dot the bluffs. American Indian hunters and French fur traders first came to the area in the 1830s followed soon afterward by fishermen, lumberjacks, mariners, and farmers.


Munson Home Care is a nonprofit organization with 500 employees and an average daily census of 1,700 patients based in Traverse City, Michigan. We provide home healthcare, hospice, palliative, private duty, and home medical equipment services to 24 northern Michigan counties. As the clinical nurse education specialist for Munson Home Care, I often ride along with nurse case managers on home visits. The following is a blending of my observation of Munson Home Care nurses and my own experiences as a home care nurse.


Old Mission Peninsula is the birthplace of Traverse City and was founded in 1839. The peninsula juts out in the middle of Grand Traverse Bay and sits squarely on the 45th parallel. Eventually a bustling community was established at the tip of the Peninsula but in 1852 settlers decided to move the mission across the bay to the Leelanau Peninsula; thus, dubbing the original mission "Old Mission." Old Mission Peninsula divides the Grand Traverse Bay into East and West Bay.


In the morning I had the opportunity to ride along with the nurse to visit a patient who had recently been diagnosed with cancer. As we drove, the road started to ascend through vineyards until we reached the pinnacle of the point known as Winery Hill where one can see both East and West Bay. The view is beyond grand and often causes drivers to stop their cars in the middle of the highway so they can take it all in. As an observer on this visit I was able to see the relationship this nurse had with the gentleman we visited. The patient was doing well but concerned that he would wear out his wife of more than 50 years with his increasing care needs. She, in turn, was concerned that her husband was so ill. The nurse provided much needed reassurance to both, and helped them navigate the complex healthcare system they were now part of.


That afternoon I rode with the nurse who covers the Leelanau Peninsula, which is situated directly across the bay from the Old Mission Peninsula, to visit patients on the Peshawbestown Reservation. The Grand Traverse Tribe of the Ottawa and Chippewa date back to the Anishinaabek people who occupied the Leelanau Peninsula in the 1830s. Peshawbestown is said to be named after the ruling Chief PeShaube in 1895. We visited a patient on the reservation who recently had surgery. The nurse had a well-established rapport with this patient and it was easy to see that a friendship that transcended cultural differences had developed.


This visit reminded me of a past patient I had cared for in Peshawbestown. My patient was of obvious Native American heritage but what was more striking was his demeanor. He was subdued and watchful, not making direct eye contact with me, which to a Native American can be interpreted as rude or challenging. Following his lead I avoided direct eye contact as well. I noted during the time that I provided education to my patient on self-injection of medication his family members stood quietly in a semicircle around us looking on; ever present and attentive but never interrupting the exchange in any way. This behavior represents the clan way of living that many Native Americans continue to practice. A clan is a group of people united by actual or perceived kinship; often descending from one ancestor. The bonds may be merely symbolic or in this case strong and palpable.


As we headed back through the reservation I noted most of the houses looked the same and I wondered if this was by choice of the tribe or forced upon them. As we passed the traditional sweat lodge and POW WOW grounds, I was reminded of the tragic loss of culture these people have endured and it saddened me.


On the way home we decided to stop in the little town of Empire, known as the gateway to the Sleeping Bear Dunes National Lakeshore. The population of Empire is just 375 people; however, over 1.3 million people visit annually. I once visited a patient here in his beautiful home, which he referred to as a "cabin," but which resembled more a luxury resort than a cabin. During assessment the patient revealed his educational level as a PhD, now retired. Being a doctoral student myself, we launched into a discussion on doctoral preparation, both being surprised to meet the other in the sleepy town of Empire. After changing his surgical dressing, providing education that I felt more than a little intimidated to deliver, and laughing with my patient who admitted he felt woozy when seeing a needle, I drew his blood samples and left him in the capable hands of his wife.


Home care nursing provides a unique opportunity for nurses to deliver both primary and preventative care to people where they are most likely to heal: in their homes. Initiatives within the Affordable Care Act emphasize the importance of caring for patients individually in order to positively impact their health status. I believe home care clinicians may have the best opportunity to do this-more so than other clinicians who must focus on tasks and timelines. As an older nurse I've learned to treasure the wide variety of experiences home care provides, and use those experiences to develop a more patient-focused sense of the reality of what health and illness means across many different cultures. Traverse City Michigan is not only a beautiful area geographically, but also a beautifully diverse community in which to practice home care.


Photo on previous page courtesy of the The Grand Traverse Tribe of the Ottawa and Chippewa Indians.