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"Condoms, vaccines and games"

January 8, 2006 --Today the Detroit Free Press ran a long, generally good story by Patricia Anstett about Wayne State University (WSU) nurse practitioner Mary White. The piece focuses on the innovative methods White uses to teach the students "how to take care of themselves." These include health-oriented "Jeopardy!" contests and "condom bingo" in the dormitories. Despite some maternal and angel imagery, the article is a pretty good portrayal of the work of an effective public health nurse.

White, a nurse for 30 years, runs a health clinic called the WSU Campus Health Center. The piece highlights her efforts to reach the young students through non-traditional methods. Her "Jeopardy!" gatherings are what sounds like a raucous evening of health-themed entertainment in which students answer "questions about cold remedies, germs and health prevention strategies." They appear to involve pitting dorms against each other, and prizes include juice, hand sanitizers, and tissues. The game the reporter witnessed, with about 20 students, apparently covered meningitis, avian flu, the common cold, and other contagious diseases. A PhD student from Jordan reportedly said that what he learned from the game was to "keep everything clean and stop touching people"--which does seem like a pretty sound health strategy, at least. White's "condo*m bingo" program uses packaged condo*ms instead of the standard bingo tokens. And she has reportedly arranged "slumber parties" in which female students "don't really spend the night but do show up in their PJs to ask personal questions in a nonclinical setting."

White explains that reaching students with key health messages requires "unusual" approaches because they already sit in lectures all day, and because health may not especially interest them. Reasons for that include that they're young and most feel healthy, that they are stressed and busy, that some of the health issues they confront may be embarrassing (like STDs), and that they are used to their parents taking the lead in looking after them. But the piece notes that student health is important because college students are at a vulnerable stage. They are living in close quarters and sharing things, engaging in more sexual activity, and some serious mental problems may begin to manifest at this age. The piece includes a sidebar with top college health issues, which include weight problems, substance abuse, and irresponsible sex. Another sidebar, based partly on White's advice, lists items every college student should have on hand, including bandages, antihistamines, and a thermometer.

The piece explains that the clinic was founded after WSU built three new dorms. WSU College of Nursing dean Barbara Redman and others at the nursing school formed a nonprofit organization to run the clinic, which is staffed by White and other faculty NPs. Redman explains that college is a critical time in which people form health patterns that they may follow the rest of their lives. One sophomore says she has used the clinic for sinus headaches and pneumonia, and that it is much more convenient than "trekking to her doctor's office five miles away." The piece does not note that, in addition to convenience, research suggests that NPs also provide care whose quality is at least as good as that of physicians. A German exchange student explains that White immediately diagnosed and treated him last year after his immune system broke down soon after his arrival in the U.S. Among White's common activities are dispensing cold medicines, giving shots for meningitis and TB, and diagnosing STDs. She is training to become a sexual assault nurse examiner so she can handle rape examinations. And she also recommends alternative health approaches, like Korean hand therapy. White is a clinical instructor at the nursing school, and the founder and treasurer of the Michigan Council of Nurse Practitioners.

There is some unfortunate maternal and angel imagery. The piece notes that White is approachable and "cool," but is also "a nurse first and foremost, with all the loving compassion the term typically conveys." Yuck. Nurses are skilled professionals, and while interpersonal skills are important, the association of the profession with "loving compassion" (also known as unskilled handholding) is a major a barrier to nurses getting the resources they need to overcome the current crisis. Later, the piece notes that at the clinic, White is "all pro, plus surrogate mom." No, no, no. Nurses are not Mom. Of course we can understand why an older female nurse might seem like Mom to students, and the piece includes a quote in which the sophomore refers to White as "like a mom to me now." Even White herself refers to the maternal perception in describing her appeal to the students: "I'm the mom image, but I'm safe because I don't lecture them." But the association of nurses with maternal imagery is a destructive nursing stereotype that we think journalists and nurses should avoid. Mom does not know how to [insert complex nursing task], and Mom is not hosting condo*m bingo. Maternal imagery also discourages most men from becoming nurses. Even if nurses use the Mom thing to help them care for individual patients, it remains bad for nursing as a whole, and for public health. At least the piece does include the "all pro" part, and later quotes Redman as saying that White is a "very experienced nurse practitioner who has a wonderful personal style with students," which is a better way to put it.

We thank Ms. Anstett and the Detroit Free Press for this generally good story.

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