Molly Johnson, MSN, APRN-CPNP, Associate Professor of Nursing, Coordinator of Program Assessment and Evaluation, Ohio University School of Nursing
In our mission to invest in the next generation of health equity leaders, this year we awarded 25 scholarships to students and working professionals so that they may attend the 2019 National Summit on the Social Determinants of Health in San Diego, Calif. Oct. 20-22. Our Scholarship Spotlight Series highlights the student leaders in the movement to build health equity who will be attending the summit. Over the next few weeks, we will be highlighting some of the scholarship recipients.
Achieving wellness is not a single-care-fits-all delivery system. Understanding the community, its inhabitants and the access they have is imperative to delivering quality care.
As a life-long resident of Appalachia, Molly Johnson MSN, APRN-CPNP understands the unique caretaking that must be considered for residents in her area. Johnson was born and raised in eastern Kentucky, where her father worked in a coal mine and her mother was a stay-at-home mom. She received both her Bachelor’s and Master’s degrees in Nursing and has 18 years of experience in pediatric nursing and matriculating as a university nursing professor. She is currently a doctoral candidate of Nursing Practice at Northern Kentucky University and will graduate in August 2020. Her love of the nursing process motivates her to provide better wraparound services for children in particular, with a social determinant lens as guiding practice.
Johnson believes that knowing your patients is the best way to treat them and gives insight into how best to treat the community at large. Residents in Appalachia where she grew up have a strong sense of family and community, retain hardworking values and are extremely resilient. Unfortunately, the residents in this area have also been susceptible to poverty and loss of energy manufacturing jobs in the region has left many out of work. “Physical isolation created by the geography makes access to resources difficult,” Johnson said. “Close family ties have prevented many from leaving the area to find work for fear of losing the security of family, and thus we have a serious poverty problem.”
Getting to the root of the health problems is a family affair that does not only affect the individual being treated. “When you work with Appalachian families, it’s often not just the patient and their parents, it’s often the whole family unit. Many grandparents are involved heavily in the care,” Johnson said. As a provider, respecting the wisdom of the elders and incorporating them in the care plan is a priority for Johnson. Also, reversing years of how people think about their health is critical. They may feel that chronic conditions like asthma or obesity are out of their control because it runs in their family.
Before delivering care, Johnson must take into consideration any widely-held beliefs and customs of those in her community to provide assistance that the patient will be receptive to. For example, social stigma may be a factor preventing people from seeking health care services. Johnson may compare seeking mental health services to taking an antibiotic for a cold, so that patients understand that this is a part of their health that also needs to be taken care of. “Perceptions of stigma about services are really important to address because they are directly related to service seeking behaviors,” Johnson said. Even if patients and families are receptive to care, other factors of poverty may come into place. Johnson says many parents who work industrial jobs like construction or labor may not get sick leave that permits them to seek out medical attention, or the next specialist may be miles away, and access to transportation could be an issue. Furthermore, mistrust may develop towards a provider who is not from that area.
Medical providers need cultural competence in order to properly address social determinants of health. They also need training in a comfortable environment so that they feel confident and competent in addressing the needs of families. “It’s not just about handling the screening tool, it’s about responding to the needs that are identified in an empathetic way so that you can maintain that trust,” said Johnson. Offering social screening simulations on real patients in a safe environment with experts to provide feedback may help ease anxiety, if incorporating social determinants into care is a new avenue for providers.
Having always been one to serve others, Johnson wants to involve the community in the care process, so she may learn how to provide the best services to suit their lifestyle and needs.
“When I finish my degree I would like to expand social determinant of health screening to the local schools and health clinics, and explore the possibility of using our Social Work and Nursing students as community navigators… linking patients to community resources…I believe that we are all responsible for the welfare of the children at the micro-community level – preschools, pediatric offices, even churches,” Johnson said.