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?
2. What are some of the physical environmental, sociocultural, and behavioral factors
operating in this situation?
3. What primary, secondary, and tertiary prevention measures are appropriate for Mr.
Kelbert and for others in his aggregate?” (p. 721)

Adapted from

Clark, M. J. Community Health Nursing, 5th ed. Upper Saddle River, NJ: Prentice Hall, pp. 720-
721.