Assignment: Milagros Amaro is a 23-year-old Mexican American migrant agricultural worker who is traveling the migrant stream with her husband, Reynaldo; her mother, Rosa; and their three children, 6-year-old Carmencita, 4-year-old Angel, and 17-month-old Rosamel. Milagros and Reynaldo are currently harvesting peaches in a region of South Carolina known as the Midlands. They work long hours. When the weather is dry, they are in the orchards 7 days a week from 6 a.m. until dusk during the peak season. On rainy days, they work in the many packing sheds preparing fruit for shipping. There is plenty of work available; however, the season is short. While they are in the orchards, Rosa cares for the children in the migrant camp provided by the grower

Assignment: Milagros Amaro is a 23-year-old Mexican American migrant agricultural worker who is traveling the migrant stream with her husband, Reynaldo; her mother, Rosa; and their three children, 6-year-old Carmencita, 4-year-old Angel, and 17-month-old Rosamel. Milagros and Reynaldo are currently harvesting peaches in a region of South Carolina known as the Midlands. They work long hours. When the weather is dry, they are in the orchards 7 days a week from 6 a.m. until dusk during the peak season. On rainy days, they work in the many packing sheds preparing fruit for shipping. There is plenty of work available; however, the season is short. While they are in the orchards, Rosa cares for the children in the migrant camp provided by the grower

Assignment: Milagros Amaro is a 23-year-old Mexican American migrant agricultural worker who is traveling the migrant stream with her husband, Reynaldo; her mother, Rosa; and their three children, 6-year-old Carmencita, 4-year-old Angel, and 17-month-old Rosamel. Milagros and Reynaldo are currently harvesting peaches in a region of South Carolina known as the Midlands. They work long hours. When the weather is dry, they are in the orchards 7 days a week from 6 a.m. until dusk during the peak season. On rainy days, they work in the many packing sheds preparing fruit for shipping. There is plenty of work available; however, the season is short. While they are in the orchards, Rosa cares for the children in the migrant camp provided by the grower

Read the following two Case Studies and answer the questions presented.

1. Case Scenario: Milagros Amaro located in Chapter 8 on page 149

Milagros Amaro is a 23-year-old Mexican American migrant agricultural worker who is traveling the migrant stream with her husband, Reynaldo; her mother, Rosa; and their three children, 6-year-old Carmencita, 4-year-old Angel, and 17-month-old Rosamel. Milagros and Reynaldo are currently harvesting peaches in a region of South Carolina known as the Midlands. They work long hours. When the weather is dry, they are in the orchards 7 days a week from 6 a.m. until dusk during the peak season. On rainy days, they work in the many packing sheds preparing fruit for shipping. There is plenty of work available; however, the season is short. While they are in the orchards, Rosa cares for the children in the migrant camp provided by the grower.

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The Amaro family generally works in South Carolina each year from the end of May until the end of July. They then move on to North Carolina to harvest vegetables and tobacco, then on to Delaware for tomatoes and peppers, then continue moving northward to New Jersey, Pennsylvania, and finally to New York to harvest onions, apples, and winter vegetables. When the season ends, they return to their home base in Frostproof, Florida, where they reside with Reynaldo’s extended family. They harvest citrus fruit throughout the winter months, then prepare for their annual trek upstream.

Milagros tells the NP at the migrant health clinic that she is experiencing pain on urination, right-sided flank pain, and a low-grade fever. She suspects that she has a urinary tract infection (UTI). She would also like to discuss family planning issues. She is currently taking oral contraceptives and has questions about their long-term safety. She also would like the children to have physicals and to catch up on their vaccinations. Her command of English is excellent. She is a U.S. citizen and was raised in Florida. Carmencita is fully bilingual and Angel knows many words in both languages. Milagros tells the NP that her husband knows some English but is more comfortable communicating in Spanish. She states that Reynaldo has a hernia but is reluctant to come to the clinic for two reasons: First, he is a Mexican citizen who has an agricultural worker visa, which has now expired. Second, his hernia is in the groin area, and he feels self-conscious about having an examination.

As the NP completes the health history on the Amaro children, she learns that Milagros does not have their vaccination records available. She shares information about when and where their vaccinations were administered. She has a variety of cards with her that identify a number of clinics where they sought services while traveling the stream. The NP notices that Milagros’s surname is different on some of the cards and asks the clinic’s social worker to telephone the clinics and request that health records be faxed after Milagros signs a consent form.

Physical examination of the children reveals that all are above their recommended weight for height. Otherwise, they are healthy youngsters who have achieved their developmental milestones. The two older children are curious about the NP’s activities, and they want to listen to their heartbeat. Their mother disciplines them verbally, and they quiet immediately.

While a nursing assistant talks with Carmencita and Angel about healthy snacks, the NP obtains a urine sample for culture and sensitivity from Milagros. She encourages her to increase her intake of water and juices and to take an over-the-counter analgesic as needed. Milagros explains that she does not have a kitchen or refrigerator in her room at the camp; all meals are taken in the camp’s cookhouse. She therefore has minimal control over her family’s diet but feels she can request extra fluids. The NP asks Milagros to call for her lab results in 48 hours to learn if she will need to begin antibiotic therapy. She then asks about Milagros’s current contraceptive practices and provides her with information about other options.

The social worker returns and states that she cannot reach any of the clinics other than the one in Florida because they operate only during the harvesting season. The records from the Frostproof clinic do provide a list of immunizations received there and dates of administration. The social worker also accessed the Migrant Clinicians Network, but the only information in its database came from the Frostproof clinic. After the nursing staff expresses frustration, the NP decides to begin immunizing the children using the Centers for Disease Control (CDC) Catch-Up Schedule based on the official records from Florida. She also orders that a TB skin test be administered to the children and to Milagros. The NP tells Milagros that if her urine culture does not indicate infection and she therefore does not need to return to the clinic, she will drive out to the camp to read the skin tests. She then faxes the information about today’s immunizations back to the clinic in Frostproof. She also gives a copy of the vaccination records to Milagros. She asks if Milagros’s mother has any health-related needs. Milagros replies that Rosa takes medication for hypertension but her supply has run out; she requires a new prescription. The NP suggests that when Reynaldo visits the clinic it would be beneficial for him to bring Rosa with him for a blood pressure check and a prescription if indicated.

Questions:

• What is the response of the staff to Milagros’s incomplete health records on her children? What assumptions underlie this response?

• How could the N.P best communicate with Reynaldo while preserving his rights to privacy and confidentiality?

• What health-related issues are essential when caring for migrant agricultural workers? Why are these health-related issues important?

• What attributes do nurses working with migrant agricultural workers need to refine to function as effective advocates for their patients?

Scenario 4: John

John is a friendly and outgoing 23-year-old college senior with short hair, a slight build, and a thin beard. He and his friends were ecstatic after their team won its National Football League (NFL) division championship and would be heading to the Super Bowl. They were walking from the stadium to the local bars to celebrate when an impatient drunk driver leaving the game jumped the curb and hit him. John’s foot caught in a grate in the sidewalk, twisting his leg and breaking it, and he had fractured ribs. John was barely conscious and in incredible pain. The paramedics rushed him to the ER where the staff worked quickly, cutting off John’s clothes so they could attend to his injuries. They saw the tightly bound breasts under his team sweatshirt and T-shirt as they removed his clothing. John’s driver’s license indicated his name was Jeanne and listed his sex as female. John had been transitioning in college, and hoped to have the money to change legal documents and obtain top surgery as he began working after graduation

• How many interactions have you had with people who identify as LGBTQIA? Would you have known at the time that your patient was LGBTQIA? How might these experiences have prepared you for interactions with patients like John?

• What role do you play as a nurse when John’s family and friends become aware of his gender reassignment plans?

• What are some best practices that organizations can put in place to foster a more welcoming environment for patients who are LGBTQIA? Would you recognize when you need help to approach John’s situation because you are uncomfortable working with someone like him?

• Describe heterosexism, cissexism, homophobia, and transphobia exist? What steps should a nurse take to address these biases?

• What is the most sensitive way to elicit information about health practices that allows the LGBTQIA patient to answer questions honestly and enables the nurse to complete a practical assessment?