Winona Begay
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”.
Discharge Planning
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.
Journey
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.