Case Study

Nursing in a Rural Setting

“You are a rural community health nurse assigned to the county health department
mobile van visiting a large migrant community at a local farm. Mr. Robert Kelbert is a 64-year-
old African American migrant worker who comes into the mobile unity to have his blood
pressure medication refilled. He will be in the county for the next 3 to 4 weeks to harvest the
soybean crop. He usually attends a rural health clinic in the northern part of the state where he
has been receiving his care and medications free.

Today, his blood pressure is 154/98, pulse 88, height 69 inches, and weight 198 pounds.
He states he is “worn out” from the heat. He chews tobacco and drinks alcohol “some.” He
travels and stays with family. His daughter-in-law does the cooking. During your interview, Mr.
Kelbert tells you he is worried because two of the migrant workers have been given medicine
for lung congestion and one of them has been coughing up blood.” (p. 720)

1. “In what ways is Mr. Kelbert’s situation typical of that of migrant farmworkers? In what
ways is he different?

Mr. Kelbert is typical of other migrant farm workers in that he is not tied to one specific
community. Given that he moves seasonally he and other migrant farm workers do not have
access to a dedicated primary care provider. Ethnic minorities disproportionately represent
migrant agricultural workers. Ethnic minorities such as African Americans and Hispanics are also
at an increased risk of hypertension. In these ways he could be considered typical of a migrant
farm worker. Migrant farm workers are also more susceptible than the general population to
respiratory problems caused by exposure to pesticides. They are also at a much higher risk than
the general population for exposure to tuberculosis.

What makes Mr. Kelbert different than the typical migrant worker is that he lives with family.
Migrant workers are typically physically separated on a seasonal basis from families that they
support. He is also enrolled in a program that provides medicine and visits for free, unlike other
migrant farm workers without a permanent address, documentation or the language
proficiency to navigate community healthcare resources.

2. What are some of the physical environmental, sociocultural, and behavioral factors
operating in this situation?

Physically Mr. Kelbert is nearing the age of 65 which physically places him at a much higher risk
for hypertension. He also describes physical fatigue brought on in part by his demanding work.
Tobacco products also increase blood pressure. Mr. Kelbert is exposed to high concentrations
of pesticides in his work environment. The quality of low income temporary housing also poses
environmental hazards to Mr. Kelbert’s health. Research has demonstrated that education level
is negatively correlated with tobacco use. Mr. Kelbert and other migrant workers with low
educational attainment levels are more likely to smoke and consume alcohol at unhealthy levels
than workers in other sectors with higher education attainment levels. The TED video ties the
detrimental effects of frequent moving and education. Community health nurses must
understand that tobacco products are highly addictive which makes behavioral modification
difficult. This is also true with unhealthy alcohol consumption. By seeking help in the clinic, Mr.
Kelbert is exhibiting positive behavioral traits.

3. What primary, secondary, and tertiary prevention measures are appropriate for Mr.
Kelbert and for others in his aggregate?” (p. 721)

Primary interventions would focus on the prevention of hypertension through programs

focused on healthy food preparation, avoiding tobacco products and discouraging excessive
alcohol consumption. Another primary intervention could focus on administering vaccines to
prevent the spread of diseases such as influenza in close quartered living situations. Secondary
interventions would focus on screening high risk populations for disease. Screening migrant
workers with ethnic and lifestyle risk factors for hypertension would be appropriate. Tertiary
interventions focus on the management of chronic disease in a population. Keeping Mr. Kelbert
current with his antihypertensive medication would be an example of tertiary intervention as
well as education about a low sodium diet.

Citations

American Lung Association. (2010). African americans. About Smoking

http://www.lung.org/stop-smoking/about-smoking/facts-figures/african-americans-

and-tobacco.html?referrer=https://www.google.com/

Connor, A., Layne, L., Thomisee, K. (2010). Providing care for migrant worker families in their

unique sociocultural context and environment. Clinical Practice Department.

doi: : 10.1177/1043659609357631

Clark, M. J. Community Health Nursing, 5th ed. Upper Saddle River, NJ: Prentice Hall, pp. 720-

721.
Lopez, U., wapilla, V., & Sanchez, P. (Actor). Romano, R. (Narrator). (2011). Children in our fields

TEDxFruitvale. Retrieved from https://www.youtube.com/watch?v=hFGLqkDnSVI