Being Aware of the culture of camp is often as important as other forms cultural awareness in the practice of camp nursing.
Samantha, age 15, is in the waiting room of the clinic with a painful ankle from a basketball injury. You are wrapping up charting from earlier in the day and ask her to wait a few minutes. After giving her an ice pack, you will fully assess in just a bit. After 10 minutes (time got away from you) you realize that she left without treatment or assessment. “Must not have been so bad” you think to yourself in a huff. What you have failed to realize is that Samantha is a wise owl, being her last year on camp, and right now is campfire. To you it’s singing songs and roasting marshmallows, but to Samantha, it is a tradition she has enjoyed every summer since she was seven; a treasured memory in a chapter of her life that will soon be closed when she ages out of camp next year. Samantha literally chose to play hurt rather than miss out on this important part of the culture of camp; a culture that she has been immersed and participating in every summer since she can remember. It is a culture that is as important to her as many other traditions and practices that her family at home practice. As nurses we often fail to grasp how serious the culture of camp is to the population we serve, and that our lack of cultural awareness can hinder our jobs as nurses. Camps have their own culture, and the culture of your camp was not installed this year. It has grown over the years, influenced by camp staff as well as campers. Camps are little islands of civilization in the sea of humanity, safe havens where children can grow and develop. As nurses, we must practice cultural awareness around this in culture of camp, as in addition to outside cultural needs. It may seem trite, but to the longtime staff and campers the culture of camp is of extreme importance, and failure to adjust the nursing process will hinder care.
Nurses should try to integrate into culture of camp as much as possible. The health center should be accessible, without becoming a hangout for malingers. It should, as much as possible, accommodate events and rituals that are important to the campers. Staff should never feel that they are fighting the health center and parents should be assured their children are medicated and healthy, while enjoying minimal interruptions to the camp experience. However, often the health services find themselves at odds with culture of camp and routine.
Camp nursing differs from other settings because healthcare and nursing are not the primary focus of the staff around us. Some nurses have trouble understanding this. In a hospital or other health care facility, all support services revolve around the patients’ health and well being. However the primary goal of camp is fun; and we often have to adapt our practice around that rather than camp bending to our needs. We as camp nurses should try and view the health center as a vital support component, we exist to make sure medical needs are met and people are safe. If we are doing our job correctly, most of camp will never have to put much thought into our existence. However, our jobs, like so many at camp, are vital to operations but mostly unseen by the campers and consumers.
Camp health services should focus on being informed, integrated, and present in camp routine and culture. That is not to say health services cannot be provided without these principles, but services that do not achieve these will feel like they are fighting for the wellness of campers against the rest of camp to a greater degree than services who are fully present in camp. Improved cultural awareness and inclusion of health services in camp culture will also increase satisfaction of the nursing staff. Camps are amazing places that nurses will often not fully experience if they are existing in a bubble of isolation and tension with the existing culture of camp.
The level of cultural awareness and harmony of health services in a camp is measured on four levels: absent, informed, integrated, and present. Each health service must decide what level they wish to exist in. Again, awareness of culture of camp is not mandatory, just encouraged.
In camps where cultural awareness and integration are absent, the health services are functional but exist in a state of agitation. It often feels as though other departments are "dumping" on the health center with no regard for how hard the job is already. Tasks are presented by management at the last minute, and often the relationship with the camp director seems strained. Little or no support is felt for simple health tasks like med passing and trip packing. The health service feels like they are tolerated, only because they are required to keep the camp open. This is not a pleasant place to be for a health service; and its staff is often very unhappy with working conditions and feels unappreciated.
The next level of understanding is being informed about culture of camp and routine. This is often the easiest step to take for departments where awareness has been absent. Camp culture is taught to the new counseling staff every year, often in organized orientation. Despite how busy setting up the health center may be, try to attend selected sessions of new staff orientation. Work with your camp director to get an idea for what portions of the orientation program may be helpful to attend. This will not only help with cultural awareness, but will make the nurses known to staff, and more accessible. Also subtle health teaching may occur organically between the nurse and cabin staff. Be sure that nurses have a complete understanding of staff responsibilities, the daily routine, and what is expected of campers and staff for manners and behavior. This can often improve working conditions for nurses, simply by giving prospective of how camp works and helps relieve frustrations from simply not understanding the world outside of the health center.
Once health services are informed and aware of culture of camp, they can be integrated into culture of camp. This is an ongoing process and is generally accomplished at the management level by increasing communication on all topics, not just health concerns. Make sure the health service is included on all messages regarding trips, scheduling, and specific issues with campers as appropriate. This will be a bit of information overload, but being over informed is often better than being under informed. Additionally, the health manager or charge nurse should be part of the management team, and be present at management meetings and daily meetings. This can be a pain in the neck but it facilitates communication and increases the perception that the health service is part of camp; just like activities, program, and swim. Both email and meetings can be used to achieve the outbound flow of information as well. Campers with appointments, new diagnoses, or who are malingering can be discussed and plans formed. Positive feedback can and should be provided as well. For example, if all the boys came and got medications without having to be tracked, that absolutely deserves a public shout out to the cabin and head staff who helped make that happen. I assure you it didn't happen on its own.
Finally, and the most difficult thing to achieve is being present in culture of camp. Health care on camp must often exit the health center to really reach the entire camp population. This requires both staff and management level nurses to commit to living the camp experience. Taking time not required in the day to day running of the health center to get out and participate in activities; go for a walk, or assist in a big camp program event. This allows staff to keep contact with counselors, leaders, and campers about concerns and be present about camp, allowing proactive health care. Often campers and staff will just say something in passing about a bad rash or a persistent sore throat, then a simple on the spot exam reveals a raging communicable disease. Many "tough" kids and counselors will neglect themselves health-wise. They would never come up to clinic call, but are more than happy to show off their athletes foot, bizarre rash, or randomly swollen limb on the bunk line. At first this feels impossible, nurses often have what seems like a never ending amount of work in the health center and may be so stressed at the end of the day they just want to hide in their room, but TRY to get out and about at least once or twice a week. You will have fun, be more effective at your job, and be a help to the staff; which means they will be more eager to help you.
If culture of camp does not include the health service, realize that change will not happen overnight. In fact, resistance may be met from other staff. Getting buy-in from a camp director certainly helps, but often it can be a uphill fight to get the required effort from other staff and other nurses as well. Many nurses are not naturally “campy” and may have difficulty interacting with children, regardless of nursing experience. Indeed, full culture integration may not be possible if staff and nurses are not sold on the benefits or are resistant to change. If you as a nurse or nurse manager find yourself wanting to improve cultural relations between health services and camp realize that even small individual changes on your part can influence systemic change eventually, and this change is often slow and difficult to see at first.
Personally I have seen an immense culture shift in my camp over the past few years as we changed owners. The new leadership was not accepting of the health center being an island. The new directors saw the benefits of integrating health services into camp culture and worked with the head nurses to make positive changes. I would love to tell you that my camp has achieved health services being fully present in culture of camp, but we have not. If I'm honest, our health services fluctuate between all the levels of integration at varies points in a season. We get there on occasion. In the future I hope to get there frequently. It is an ongoing process, but we are moving forward, gaining momentum. That's how real change happens, not in a sweeping proclamation or big announcement, but one person at a time.
All opinions expressed here are my own and do not represent those of my employer. Remember anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.