By Jean C. Bokinskie and Tracy A. Evanson B · National Agricultural Workers Survey (U.S. Department of Labor, 2005), migrant farmworkers are employed in (58%) with an average of

202 JCN / Volume 26, Number 4

Did you know that over 85% offruits and vegetables produced in theUnited States require hand-pickingor cultivation (National Center forFarmworker Health, Inc [NCFH],2002c)? The agricultural industry isdependent upon the manual laborprovided by migrant farmworkerslike Brenda and her family.

Somewhere between three to fivemillion migrant farmworkers andtheir families travel throughout theUnited States (NCFH, 2002c) as theyfollow crops or shuttle within a 75-mile radius from their homes (Acury& Quandt, 2007). The conditions anddiscrimination experienced by theseworkers contribute to multiple health

■ Jean C. Bokinskie, MS, RN, isa doctoral student at the Universityof North Dakota, Grand Forks, ND.She is Assistant Professor of Nursingand the Director of the ParishNurse Center at ConcordiaCollege, Moorhead, MN. She prac-

tices as an unpaid parish nurse at Hope LutheranChurch, Fargo, ND.

■ Tracy A. Evanson, PhD,PHCNS-BC, is Associate Professor in the Family and CommunityNursing Department at theUniversity of North Dakota,College of Nursing and director ofthe Advanced Public Health Nurse

specialization. She has worked many years with vul-nerable populations, including migrant farmworkers.

The authors have disclosed that they have no financialrelationships related to this article.

*Supplemental digital content is available for this article.Direct URL citations appear in the printed text and areprovided in the HTML and PDF versions of this article onthe journal’s Web site (www.journalofchristiannursing.com).

2.3 contact hours

Brenda and her family have been migrating from Texas to harvestbroccoli in Maine since she was a little girl. Now Brenda is 25and having second thoughts about migrating with her young

daughter and ailing mother who was recently diagnosed with cancer.

Brenda says, “They (the workers) keep themselves strong and not go tothe doctor. It would be between $30 and $50 without the medicine; themedicine would be $80. And we can’t afford that” (Migrant CliniciansNetwork [MCN], 2008a).

By Jean C. Bokinskie and Tracy A. Evanson

Photograph by: David Bacon/The Image Works

JCN/October-December 2009 203

problems and disparities. Nurses inthe faith community, especially parishnurses (PNs), can help meet thehealth needs of migrant farmworkers,workers, and their families. This articlefocuses on farmworkers; however,knowledge of Mexican-Americanculture, cultural competence, andideas for health ministry could beused to help migrant workersemployed in other types of work.

WHO ARE MIGRANT FARMWORKERS?

According to the 2001-2002National Agricultural Workers Survey(U.S. Department of Labor, 2005),migrant farmworkers are employed in

(58%) with an average of two chil-dren. The average total family incomewas from $15,000 to $17,499; 30%had total family incomes below thepoverty guidelines. Only 23% hadhealth insurance. These families havemultiple barriers to health benefitsand support services, and those whoare undocumented face constant fearof deportation.

Agriculture is one of the mostdangerous occupations in the UnitedStates (NCFH, 2002a). Migrant farm-workers are exposed to physical stres-sors from nature’s elements (rain, hail,heat, lightning strikes, wind), andchemicals/pesticides. The strain oflong hours of manual labor, mental

over 75% of U.S. states. Less than one-half were U.S. citizens or legal resi-dents; 84% were Hispanic and 75%were born in Mexico. Spanish was thenative language for 81% of the farm-workers, and 44% reported they couldnot speak English; on average, thehighest grade completed was seventh.Most were male (79%) and married

and emotional stressors of separationfrom family members, unemployment,and long work hours add to the healthrisks. Substandard housing is a healththreat for migrant families (Gentry,Grzywacz, Quandt, Davis, & Arcury,2007; Magaña & Hovey, 2003).Housing concerns include close prox-imity to farm fields and pesticides,

vermin, lack of window screens, poorinsulation, and leaking roofs. Laborcamps frequently lack adequate show-er, toilet, and laundry facilities.Pesticide-contaminated clothing oftenis washed near food preparation areasor bathing areas (Hansen & Donohoe,2003). Work demands, poor housingconditions, isolation, lack of recreational

The Stranger Among Us:Ministering Health to Migrants

Hispanic: individuals who are MexicanAmericans, Mexicans, Puerto Ricans, Cubansor from Central and South America (NCFH,2002c)

Migrant and migrant workers:migrant (those following crops or shuttling froma home base) and seasonal (those assistingwith farm work during the tilling or harvestingseasons) farmworkers

Family: a single individual or a married/partnered couple with child(ren)/grandchild(ren)

Parish or Faith Community Nurse:an RN who serves the faith community byfocusing on the needs of the parishioner, faithcommunity, and surrounding geographic areawith attention to spiritual needs

Faith community: churches, parishes,synagogues, or mosques

Clergy: ordained and lay faith communityleaders

Terms Used in this Article


activities, and poverty have been asso-ciated with high levels of anxiety,depression, substance abuse, anddomestic violence in this population(Magaña & Hovey; NCFH, 2002c).

Hispanic migrant families experi-ence an elevated risk for obesity, cancer, stroke, diabetes, heart disease,asthma, tuberculosis, and dental prob-lems (Acury & Quandt, 2007; MCN,2008b; U.S. Department of Healthand Human Services [DHHS], 2008).In 2003-2004 the prevalence of obe-sity in Hispanic adults was 36.8%,compared with approximately 30% ofnon-Hispanic white adults (DHHS,2007b). Hispanics are 1.7 times morelikely to have diabetes as non-Hispanicwhites of similar age (NationalDiabetes Information Clearinghouse[NDIC], 2005). Low levels of exercise,unhealthy diets, and stress contributeto obesity, type II diabetes, and hyper-tension (DHHS, 2007a).

CULTURAL CHARACTERISTICSMost migrants come from Spanish-

speaking countries of Mexico, Cuba,Puerto Rico, and Central or SouthAmerica (NCFH, 2002c), wheresimilar cultural beliefs exist, although

diversity exists within groups.Healthcare providers (HCPs) shouldavoid stereotyping entire culturalgroups based on information providedby select group members as theremay actually be more diversity withinthe culture than between cultures. Inorder to provide culturally sensitiveand personalized care, HCPs mustspend time with individuals to under-stand their unique needs.

Family life in the MexicanAmerican culture is centered on theextended family, patriarchal hierarchy,and distinct family roles (Lausch,Heuer, Guasasco, & Bengiamin, 2003).Migrant families may have some com-mon cultural characteristics whichcould impede or enhance the imple-mentation of healthy behaviors.Physical activity is a part of the cul-ture; however, exercise is accomplishedthrough manual labor or walking tothe grocery store rather than throughorganized physical activities (VanDuyn et al., 2007). Heredity, obesity,poor nutrition, and stress are believedto cause diabetes in this population(Adams, 2003; Cartwright et al.,2006). Personal stressors may comefrom worrying about family members

back in Mexico, fears of deportation,and discrimination. Obesity rates forHispanics may be elevated due topoverty and cultural traditions. It is sadirony that migrant families usuallycannot afford to buy the expensivefruits and vegetables they harvest, rely-ing instead on less expensive high-fat,high-calorie, and processed foods.Childhood experiences of hunger maycontribute to the desire to eat untilsatiety is achieved (Cartwright et al.).In the Mexican culture, not engagingin celebrations by eating may be seenas being inhospitable and weight losshas been perceived as an “act of vanitywhich was not consistent with havinghumility before God” (p. 103).

Illnesses have a body, mind, spiritual,and family connection in the Mexicanculture. Nervios is a nervous state ofinsomnia or anxiety believed to becaused from chronic stress, whereassustos is a condition resulting from afrightening event and manifests asinsomnia, appetite changes, and malaise(Weigel, Armijos, Hall, Ramirez &Orozco, 2007). Formal religious beliefs(primarily Catholicism) are blendedwith traditional folk beliefs in the cul-ture’s healing practices, through tradi-tional healers or curanderos (Hovey &Magaña, 2000; Mull & Mull, 1983).Surrounded by religious icons, thecurandero employs traditional folkmedicines of massage, herbs, egg, andteas to diagnose and treat illnesses(Mull & Mull). Having received thehealing gift (don) from God, thecurandero may use prayer as a partof treatment.

ADDRESSING HEALTH NEEDS Diabetes, heart disease, and obesity

are chronic diseases that require close

Agricultural industry in the United States is dependent on migrantfarmworkers who are predominately Hispanic

The lifestyle experienced by migrant families contributes to obesity,cancer, stroke, diabetes, and heart disease

The ministry of parish nursing is an excellent way to offer healthsupport to migrant families

A Biblically Based Model of Cultural Competence isvital to provision of culturally sensitive nursing care

The seven established roles of parish nursing practice give guidance fordeveloping health programs for migrant families

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management by HCPs and self-management by the client in orderto prevent long-term complications.Health promotion activities thatincrease physical activity and promoteweight loss and selection of healthyfood choices have been shown todelay or prevent type II diabetes(NDIC, 2005). In a study on diabetesself-management, Latino patientswere able to state a number of specificstrategies related to diet, exercise,medication use, and personal care.Explanations for lack of self-careincluded lack of control over culturalinfluences, limited understanding ofhealth related information, and finan-cial concerns (Carbone, Rosal, Torres,Goins, & Bermudez, 2007).

The provision of healthcare serv-ices to migrant families is a majorconcern (Acury & Quandt, 2007).Migrant families usually do not haveinsurance or finances to pay for diag-nostic tests or treatments, release timefrom work to attend health providerappointments, or reliable transporta-tion (NCFH, 2002a). Work hoursmust accommodate the crops, there-fore most migrants are not able toaccess routine health services duringtraditional hours.

Language and cultural barriers arean issue when accessing services. It isestimated that 85% of migrant work-ers have difficulty processing writteninformation regardless of the languagein which it is presented (NCFH,2002b). Exemplar programs have beendeveloped throughout the UnitedStates to address the healthcare needsof migrant families. For example,Migrant Health Services, Inc., a pri-vate nonprofit organization servingmigrants in the upper Midwest, has

implemented a diabetes lay educationprogram to provide diabetes educa-tion and support from the spring tofall. From fall to spring, the diabeteslay educator continues providing serv-ices to the same population whenthey return home to southern Texas(Bergland, Heuer, & Lausch, 2006).

Literature related to migrant work-ers’ health lacks information aboutthe positive attributes and abilities ofmigrant families beyond the culturalstrength of family support (Lausch etal., 2003). The focus is on disabilitiesrather than abilities; offering servicesto care for because of need, ratherthan supporting self-care out of cul-tural desire, reflecting caring for, ratherthan caring about. Another model,using HCPs in creative and support-ive ways, is needed. Providers can bestserve migrant families by developingprograms built upon the population’sstrengths. Faith communities supporta sense of community that promoteshealthy lifestyles and positive healthbehaviors (White, 2001). In a studyon migrant farmworker acculturativestress, anxiety, and depression, Hoveyand Magaña (2000) noted that reli-gious affiliation fostered social support,church attendance increased copingabilities, and enhanced religiositydecreased distress.

PARISH NURSINGThe ministry of parish nursing is

modeled on the work of Jesus, whospent his life preaching, teaching, andhealing. The PN functions withinseven areas of health and healing min-istry: health educator, personal healthcounselor, volunteer coordinator,community liaison/referral agent,developer of support groups, health

advocate, and integrator of faith andhealth (Solari-Twadell & McDermott,1999). Activities within the PN rolemay include organizing health screen-ings/fairs, referring parishioners toHCPs and services, actively listeningto parishioners’ life stories, advocatingfor access to healthcare and healthylifestyles and behaviors, and offeringprayer and spiritual support. The PNis well-suited to provide culturallycompetent care for migrant familieswho are both members and guestsof the faith community, and can beassisted by other nurses in the faithcommunity. In order to do so, nursesneed a strong biblically based founda-tion in which to guide ministry andenter into a process of growth incultural competence.

BIBLICALLY BASED CULTURALCOMPETENCE

According to transcultural nurseexpert, Josepha Campinha-Bacote, “ifhealthcare professionals understoodthe truth that all human beings aremade in the image of God, it wouldset them free from racism and allowthem to care for culturally and ethni-cally diverse clients in a moral andethical manner” (TransculturalC.A.R.E. Associates, 2008). A BiblicallyBased Model of Cultural Competence inthe Delivery of Healthcare Services inte-grates intellectual and moral virtuesand provides a framework for the pro-vision of culturally sensitive nursingcare. This model, based on Campinha-Bacote’s (1999) original model of cultural competence, defines culturalcompetence as an ongoing process.There are five interdependent con-structs that must be addressed tobecoming culturally competent.


The lifestyle, living and working conditions, and discriminationexperienced by these workers contribute to multiple health problems and disparities.

Cultural awareness means that theprovider goes beyond personal biasand appreciates the unique beliefs andpractices of others. The nurse needs toacknowledge his or her own perspec-tives of migrant families’ beliefs andattitudes, in order to gain new per-spectives. Cultural knowledge requiresthe provider to explore and under-stand the client’s emic perspectivethrough sharing of one’s life story.This allows the nurse to gain insightsinto the client’s physical, emotional,and spiritual strengths and weaknesses.Cultural knowledge requires an atten-tion to learning about the individualas much as the culture. Cultural skillis the ability to gather informationfrom the client with sensitivity towardthe client’s culture and individuality.Through multiple cultural encounters,the nurse gains insight into the indi-vidual’s needs beyond the culturalnorms. Multiple encounters mayhelp in supporting self-care behaviorsof the individual. The ability to speakthe native language may not be anissue when gathering information(Kim-Godwin, Alexander, Felton,Mackey, & Kasakoff, 2006), rather itis the ability of the nurse to showunconditional acceptance of the client.Cultural desire is the internal drive tocontinue in the ongoing process ofcultural competence. Desire is theunconditional love and caring that is

foundational in Christian teaching(Transcultural C.A.R.E. Associates,2008).

DEVELOPING CULTURALAWARENESS

To begin the process of culturalcompetence, the PN and other nursesin the faith community need to becomeaware of the presence of migrant fam-ilies. The PN needs to work with faithcommunity members and clergy towelcome new and returning families.Hispanic art, wall hangings, and blan-kets may be placed in the church set-ting as a way to provide a welcomingatmosphere (Lausch et al., 2003).Bulletin boards and brochures inSpanish are an inviting gesture.

Clergy and nurses can meet withmigrant families to assess their spiritualneeds, understand their cultural prac-tices, and hear their individual stories.In a study on health needs of immi-grants and refugees, a provider stated“Number 1: listening, number 2: listening, and number 3: listening.Learning their stories, knowing whatmakes them function, what touchestheir hearts and souls is important inorder to help them…” (Fennelly, 2006,p.199). Respecting and understandingothers is important in developingtrusting relationships in this population(Kim-Godwin et al., 2006). In closecollaboration with leaders in the

migrant community, the PN and cler-gy can develop programs to meetexpressed needs. Multiple ongoingencounters with faith communitymembers may help to develop rela-tionships and provide a more openopportunity for migrant families torequest assistance (Clingerman, 2007a).Ideally, it would be beneficial to havea Hispanic nurse who has in-depthunderstanding of the cultural values,beliefs, and practices. In the absence ofsuch an individual, Spanish-speakingnon-Hispanic nurses or others couldbe used to assist with interpreting,developing, and implementing programs.

PROGRAM IDEASIdeas for programs that could be

implemented with migrant families arelimited only by the faith community’sbeliefs and nurses’ creative limitations.Health-related programs should beoffered during nondaylight hours,when migrant families can accessthem. Annual evaluations of programsare necessary to make changes beforethe next season and should include theinput and perspectives of the partici-pants, in order to effectively identifysuccesses and areas for improvement.Furthermore, it is essential to publishinformation about effective programsto the greater healthcare communitysince the evidence base in this area islimited.


Because of the large number of ille-gal immigrants among migrant farm-workers, churches can have concernsabout the legalities of assisting migrantfamilies. Information about legal andillegal support to illegal immigrants isavailable as supplement digital content,“Helping Illegal Immigrants: What Isthe Law?” at http://links.lww.com/NCF-JCN/A1.

Specific programs that might beoffered within the PN role to supportmigrant families include the following:

Integrator of Faith and Health. Workingin collaboration with a local curanderoand clergy, the PN can provide cul-turally appropriate care that supportstraditional folk and religious beliefs.Offering healing and worship servicesand prayer groups in Spanish mayreduce feelings of sadness or home-sickness experienced by non–English-speaking church-goers (Clingerman,2007b). The PN could sponsor educa-tion focusing on the importance ofdeveloping balance in life; the rela-tionships between physical, emotional,and spiritual symptoms and variousdisease states; and ways to promotewholeness when cure is not possible.

Developer of Support Groups & VolunteerCoordinator. The work season formigrants may last a few weeks to afew months. Regardless of the timespent in one location, a sense of safetyand belonging are important. Socialsupport provides a sense of belongingand identity among Mexican Americanfarmworkers (Hovey & Magaña, 2000).The PN can provide opportunities forparents and children to discuss concernsabout transient lifestyles, parenting con-cerns, and stress from leaving familymembers (Magaña & Hovey, 2003).Clingerman (2007a) found that

migrant women attributed importanceto the time required to prepare physi-cally, emotionally, financially, and spiritu-ally for the next phase of migration.Support for the women could be pro-vided through opportunities to discusstheir feelings, or by engaging the helpof other nurses and faith communitymembers to assist with childcare orpreparations for the move.

In order to foster cultural awarenessin the larger faith community, thePN can sponsor education regardingMexican American culture for faithcommunity members. Education onunique needs, faith beliefs, and valuescan assist the community in developingcomfort when working as volunteersand enhance a welcoming environ-ment. Spanish classes could be taughtby those fluent in the language or byindividuals from the migrant commu-nity. The PN could facilitate discus-sions between migrant families andmembers of the larger faith communi-ty, helping both groups better under-stand each other’s beliefs and values.

Community Liaison/Referral Agent.PNs work in close partnerships withlocal organizations and are well suitedto assist migrant families in locatinghealth services. The PN may assistfamilies by connecting them with theNCFH’s Call for Health program,which locates health services informa-tion and referral resources in a region(see Web Resources). The program alsoprovides financial assistance for health-care once all other local resources havebeen exhausted.

Personal Health Counselor. The PNmay offer a listening ear and provide asupportive environment for migrantfamilies. Depression, substance abuse,and domestic violence are reported

risks, often due to isolation and eco-nomic hardship (MCN, 2008b), andpersonal health counseling shouldinclude screening for these conditions.Interactions may allow the nurse toform lasting and trusting relationshipsregardless of episodic lapses related tothe population’s transient lifestyle(Lausch et al., 2003).

Health Advocate. There are multipleways in which PNs and other nursescan serve as health advocates formigrants. For example, advocating forsafe housing by encouraging localhousing authorities to enforce qualitystandards. Faith community memberscan be enlisted to help families findaffordable housing free from rodents,mold, and pollutants. The PN canadvocate for improved living andworking conditions with faith commu-nity members who employ migrants.

On a larger scale, the PN can edu-cate and encourage faith communitymembers to serve as advocates beyondthe local community. Advocates canencourage city councils and legislatorsto develop policies that address envi-ronmental issues, healthcare coverage,and farmworker safety and supportnational organizations focused on theplight of migrants (see Web Resources).

Health Educator. The faith commu-nity is an effective location for theprovision of health promotion activi-ties to assist in chronic disease man-agement and to reduce the risks ofobesity, diabetes, and hypertensionin migrant families. Van Duyn et al.(2007) found that strategies thatincrease social support reduce barriersto physical activity in minority popu-lations. Additionally, they found thatLatina women desired church-basedexercise programs because of the safe


location. Existing exercise and nutri-tion programs can be adapted byadding culturally appropriate music,food selections, and teaching materialsin Spanish. For example, the FaithfullyFit Forever program, a faith-basedhealth promotion program devel-oped by the Parish Nurse Ministryand Cardiovascular RehabilitationServices, MeritCare Health Systems(2003), could be adapted. Hispaniclay leaders could serve as trainedvolunteer leaders and implementthe program.

Many faith communities host week-ly meals and fellowship hours, orother food-related events. These offeran opportunity for nutritional educa-tion and role modeling. The PNcould implement a culturally appro-priate version of the Nurturing YouthThrough Faith, Fitness and Food pro-gram. This program developed throughthe Concordia College Parish NurseCenter (2005), addresses nutrition andactivity issues of preteen children. Thedevotional materials and menus couldbe adapted to the cultural and dietarypatterns of the migrant population.Culturally appropriate food modelsthat reflect the portion size and typesof foods commonly consumed byHispanic populations are available.Balanced nutrition on a budget, safefood handling, and information onhow to access local food assistanceprograms also can be addressed.

Health fairs are a common sourceof preventive care for Hispanicmigrant families (Goertz, Calderón, &Goodwin, 2007). Health promotionand screening related to hypertension,heart disease, diabetes, dental, muscu-loskeletal health and vision can beincluded at a single time and location.Culturally appropriate educationalresources in English and Spanish onhealth and safety issues are availablefrom governmental or national organ-izations (see Web Resources). The PNalso can use this information to devel-op bulletin boards on health promo-tion topics. Since literacy rates are lowin this population, it is important toutilize pictures and graphics as muchas possible, rather than relying onwritten materials. The faith commu-nity could be used as a clinical educa-tion site for nursing and other alliedhealth professions. Students coulddevelop educational materials, provideworkshops, or lead exercise sessions,while gaining valuable experiencesand developing cultural competence.

Intergenerational programs ordances can nurture relationshipswithin the migrant population. Theseactivities combine group socializationwith exercise, thereby decreasingsocial isolation and improving physi-cal activity. Music should reflectappropriate culture for all age groups.Multicultural programs can educateabout the culture diversity and similar-

ities among groups within the entirefaith community.

In an effort to enhance continuityof care for migrant families, the PNcan network with other health min-istries throughout the U.S. Lay lead-ers, who are respected members oftheir communities, can be trained tofacilitate programs as well. In a mannersimilar to Migrant Health Service’sdiabetes lay educator program(Bergland et al., 2006), education andsupport of the lay leader would needto occur prior to migration from thearea. The PN and lay leader couldmaintain long distance communica-tion to share insights, discuss strengthsand weaknesses, and make programrevisions on an ongoing basis.

PNs can coordinate with localschools to offer English as a secondlanguage to help empower membersof the migrant population. In addition,health career fairs can help recruitminority students into health profes-sions. The PN, as a caring role model,can serve as the impetus for furthereducation for migrant families.

CONCLUSIONThe United States relies on migrant

workers to provide a valuable service;therefore we have a responsibility toprovide support to these individualsand their families. As believers in Jesus,followers of his teachings, and mem-bers of faith communities, we are

For information about assisting illegal immigrants and current law,see http://links.lww.com/NCF-JCN/A1.


called to care for others. The “callingto care” goes beyond the comforts ofthe local faith community. Jesus spentmuch of his ministry with the poor,ill, and outcasts—namely, the vulnera-ble. Parish and other nurses are wellequipped to assist the faith communityin providing culturally competent carefor migrant families through variousroles. In communities served by migrantfarmworkers, nurses can play a signifi-cant role in reducing health disparitiesin this vulnerable population.

Acury, T., & Quandt, S. A. (2007). Delivery of healthservices to migrant and seasonal farmworkers. AnnualReview of Public Health, 28, 345-63. Retrieved March2, 2008, from http://publhealth.annualreviews.org

Adams, C. R. (2003). Lessons learned from urbanLatinas with type 2 diabetes mellitus. Journal ofTranscultural Nursing, 14, 255-265.

Bergland, J. E., Heuer, L., & Lausch, C. (2006). Diabeteslay educator case study: One woman’s experienceworking with the Hispanic migrant and seasonal farm-workers. Journal of Cultural Diversity, 13(3), 152-157.

Campinha-Bacote, J. (1999). A model and instrumentfor addressing cultural competence in health care.Journal of Nursing Education, 38(5), 203-207.

Carbone, E. T., Rosal, M. C., Torres, M. I., Goins, K.V.,& Bermudez, O. I. (2007). Diabetes self-management:Perspectives of Latino patients and their health careproviders. Patient Education and Counseling, 66, 202-210.

Cartwright, E., Schow, D., Herrera, S., Lora, Y.,Mendez, M., Mitchell, D., et al. (2006). Using partici-patory research to build an effective type 2 diabetesintervention: The process of advocacy among femaleHispanic farmworkers and their families in southeastIdaho. Women’s Health: New Frontiers in Advocacy &Social Justice Research, 43(4), 89-109.

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Fennelly, K. (2006). Listening to the experts: Providerrecommendations on the health needs of immigrantsand refugees. Journal of Cultural Diversity, 13(4), 190-201.

Gentry, A. L., Grzywacz, J. G., Quandt, S. A., Davis, S.W., & Arcury,T. A. (2007). Housing quality amongNorth Carolina farmworker families. Journal ofAgricultural Safety and Health, 13, 323-337.

Goertz, H. D., Calderón, V. J., & Goodwin, S. (2007).Understanding health needs of migrant workers inAmerica’s heartland. Urologic Nursing, 27, 429-436.

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Hovey, J. D., & Magaña, C. (2000). Acculturative stress,anxiety, and depression among Mexican immigrantfarmworkers in the Midwest United States. Journal ofImmigrant Health, 2(3), 119-131.

Kim-Godwin, Y., Alexander, J. W., Felton, G., Mackey,M. C., & Kasakoff, A. (2006). Prerequisites to provid-ing culturally competent care to Mexican migrantfarmworkers: A delphi study. Journal of CulturalDiversity, 13(1), 27-33.

Lausch, C., Heuer, L., Guasasco, C., & Bengiamin, M.(2003). The experience of migrant health nursesemployed in seasonal satellite nurse-managed centers:A qualitative study. Journal of Community HealthNursing, 20(2), 67-80.

Magaña, C., & Hovey, J. D. (2003). Psychosocial stres-sors associated with Mexican migrant farmworkers inthe Midwest United States. Journal of Immigrant Health,5(2), 75-86.

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Mull, J. D., & Mull, D. S. (1983). Cross-cultural medi-cine: A visit with a curandero. The Western Journal ofMedicine, 139, 730-736.

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National Center for Farmworker Health, Inc. (2002c).Overview of America’s farmworkers. Retrieved September10, 2008, from http://www.ncfh.org/aaf_01.php

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Parish Nurse Center. (2005). Nurturing Youth ThroughFaith, Fitness and Food. Moorhead, MN: ConcordiaCollege.

Parish Nurse Ministry and Cardiovascular RehabilitationServices. (2003). Faithfully Fit Forever Leader Manual.Fargo, ND: MeritCare Health System.

Solari-Twadell, P., & McDermott, M. (Eds.). (1999).Parish nursing: Promoting whole person health within faithcommunities. Thousand Oaks, CA: Sage.

Transcultural C.A.R.E. Associates. (2008). A BiblicallyBased Model of Cultural Competence in the Delivery ofHealthcare Services. Retrieved March 28, 2008, fromhttp://www.transculturalcare.net

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U.S. Department of Labor, Employment and TrainingAdministration. (March 2005). Findings from theNational Agricultural Workers Survey (NAWS) 2001-2002: A demographic and employment profile of UnitedStates farm workers (National Agricultural WorkersSurvey Research Report No. 9). Washington, DC: USDepartment of Labor, Office of the Assistant Secretaryof Policy.

Van Duyn, M. S., McCrae, T., Wingrove, B. K.,Henderson, K. M., Boyd, J. K., Kagawa-Singer, M., etal.. (2007). Adapting evidence-based strategies toincrease physical activity among African Americans,Hispanics, Hmong, and Native Hawaiians: A socialmarketing approach. Preventing Chronic Disease: PublicHealth Research, Practice, and Policy, 4(4). RetrievedMarch 10, 2008, from http://www.cdc.gov/pcd/issues/2007/oct/07_0025.htm

Weigel, M. M., Armijos, R. X., Hall, Y. P., Ramirez, Y.,& Orozco, R. (2007). The household food insecurityand health outcomes of U.S.-Mexico border migrantand seasonal farmworkers. Journal of Immigrant MinorityHealth, 9, 157-169.

White, J. (2001). Mixing faith and fitness. American Collegeof Sports Medicine Health & Fitness Journal, 5(4), 15-19.

Web Resources• Farmworker Justice, Inc.—

http://www.fwjustice.org/

• Migrant Clinicians Network, Inc.—http://www.migrantclinician.org/

• National Center for Farmworker Health,Inc.—http://www.ncfh.org/

• Call for Health - 1-800-377-9968(a program of NCFH)

• Immigration Basics Fact Sheet—http://www.justiceforimmigrants.org/ParishKit/ImmigrationBasics.pdf

For more than 4 additional continuing education articles related to cultural competence, go to NursingCenter.com\CE.

Documents

By Jean C. Bokinskie and Tracy A. Evanson B · National Agricultural Workers Survey (U.S. Department of Labor, 2005), migrant farmworkers are employed in (58%) with an average of