Caring for Her People
Winona Begay, Navajo, RN, BSN, MS, is a specialty nurse and patient care coordinator at Northern Navajo Medical Center in Shiprock. As a member of the Nurse Executive Team, case management and discharge planning are two of her key tasks.
Coordinating Care/Case Management
Begay most days by joining physicians other health professionals in patient rounds [reviewing the patients and their care]. At least two or three days a week during rounds, they review all the patients in the hospital. “We work as a team with the physicians, nurses, social workers, physical therapists and others. The staff nurses, the ward nurses and the med-surg [medical surgical] nurses and nursing assistants provide the bedside care.” Begay and Sylvia Barnes, Navajo, RN, the other patient care coordinator, make sure that all aspects of the patients’ care are effectively coordinated and managed. These two Diné-speaking nurses also assist physicians and others in talking with patients and families, including interpreting complicated health information. Begay says, “When I work with patients, I like to hear their knowledge and wisdom and whatever they want to share. Elders like to tell their stories. We don’t always have time to sit with them. I value those times that I can. It’s always wonderful. I’m still learning”.
When elders and other patients are ready to be discharged from the hospital, Begay helps to prepare them to go home, by doing such things as making sure they understand any special diet they need to follow and what medications they need to take and when to take them. If they will not be able to fully take care of themselves, she tries to help them tap into available community services that can help them continue to live at home.
“Unfortunately,” Begay says, “there are very limited resources available on the reservation. We do what we can with the services that are out there. We don’t have home health agencies and venders that provide transportation and home health equipment in a large part of our service area. That’s a big need. Many of the homes, families and elders do not have access to electricity and running water. They have to go a distance for grocery stores and laundromats and routine needs.”
Being located in the Four Corners, Begay deals with patients from four states, and each state offers different services. She says, “Medicaid has the goal to help the elder people and keep them in their homes as much as possible, so they offer an in-home care program that is available in some states. In-home care includes a paid caregiver who does such things as helping with bathing and dressing and with cooking and laundry. The caregiver might also bring the patient to medical appointments. In some cases the caregivers are family members. All of the caregivers have special training. The amount of time the caregivers spends with the elders depends on their needs. This is a wonderful program.”
Begay works closely with the social workers at her medical center. She says, “The social workers also help patients obtain services. In addition, they address social issues and the nursing home placements.”
There is only one nursing home on the Navajo reservation. It cannot meet the needs of all of the people who need this level of care, so some elders have to go to nursing homes located off the reservation. “When elders go to these nursing homes,” Begay says, “everything is unfamiliar. Meals are prepared differently. Caregivers aren’t always Navajo-speaking. The nursing homes do their best to integrate cultural activities for the residents, for example, every now and then they serve mutton or have entertainment activities.” Despite these positive efforts, though, many elders still don’t feel at home.
Winona was raised by her grandparents who lived in an isolated part of the Navajo Nation. Begay recalls, “Our family lived off of the land, farming and raising sheep. My grandmother was a Christian, and the family went to the local church weekly. I have lots of respect for my grandparents,” says Begay. “Now when I see people using machines to do the work that my grandparents did manually, I’m amazed at what my grandparents accomplished.”
Begay’s grandmother wove small rugs and saddle blankets, which she sold. Begay fondly remembers how everyone worked together with such tasks as cleaning, carding, and spinning the wool.
“My grandparents encouraged us all to go to school and then return with what we’d learned and journey home to our people,” says Begay, who clearly followed her grandparents’ advice.
After attending boarding school and graduating from high school, Begay trained as a medical assistant. There were no doctors’ offices in which she could work, so she worked as a nursing assistant in a nursing home where she enjoyed working with elders.
Begay went on to become a licensed practical nurse and then earned an associate degree at what then was the Navajo Community College (now Diné College). At the hospital where she worked, she discovered that she was given the same assignments as bachelor-degree-level nurses, but she was paid less than they were. That discovery led her to earn her bachelor’s degree in nursing at the University of New Mexico.
Over the years Begay has worked in several settings, including obstetrics and the emergency department. She became a certified diabetes program educator/coordinator and worked with several generations of families. She enjoyed the fact that she had many opportunities to use her language (Diné) and that the elders corrected her, when needed, and helped her improve her speaking.
Begay has worked for the Indian Health Service at Tsaile Health Center in Northeast Arizona, at Santa Fe Indian Hospital, and at the Crownpoint Health Care Facility on the eastern edge of the Navajo Reservation. She also worked at the University of New Mexico Hospital in Albuquerque. Later she transferred to Northern Navajo Medical Center at Shiprock where she now works.
After 20 years of nursing practice, Begay took the courageous step of earning her master’s degree in public health nursing at the University of Minnesota. She did this while continuing her work at Shiprock and caring for her family. Begay confesses, “It was rough.” At the beginning of her master’s program and then periodically after that, Begay met face-to-face in Minnesota with her professors and some classmates. Otherwise, most of Begay’s work was on the internet.
Completing the master’s degree gave Begay more confidence and opened her to new resources and understandings. It stretched her and gave her a chance to be more reflective about her work. Although the program was stressful, Begay feels that the effort was well worth what she has gained. Clearly, it has equipped her to be even more helpful to her people.