Archive for June 14, 2013

ABSNs First Days in “The Holler”

We support rural health

We support rural health

What do you get when 8 ABSNs, 6 MSNs, and 1 instructor are packed into a cabin meant for half that amount? The answer is new cabin. We were hardly settled before we began our days in West Virginia, filled with tours of the different hollows/valleys or “hollers” as the residents of Cabin Creek say. These are the areas typically near creeks, where people are able to build communities. We also learned about the impact the coal mining industry and mountain top removal sites have had on this community.

We will never know what was said during this conversation between our tour guide and an employee of a big coal company…

The main clinic in the Cabin Creek community was initially established to support coal miners with Black Lung Disease and their families. Many patients

in both the Cabin Creek Health System and New River Health System, where students are placed, have generations of families that have lived in these communities their whole lives. This is a valuable characteristic for rural West Virginia, because our approach for tackling our quality improvement project relies on oral histories.

The administrative and medical staff have tasked the ABSN “SWAT Team” with discovering the story of patients that have had over 2 hospital admissions over the past 12 months.

Plugged in doing chart reviews

Plugged in doing chart reviews

The admitting conditions are related to Chronic Obstructive Pulmonary Disease, Chronic Heart Failure, Hypertension, Diabetes Mellitus, and others, which are typically managed in the primary care setting.

What are the barriers these patients face with managing their conditions? Statistics can only tell us so much, and we want to take a culturally sensitive approach. We will do this by hearing their stories. We are busy reviewing charts and have interviews set up after clinic/shadow time with our preceptors in the morning.

I will keep you posted. Please visit my twitter account @AshEliseMPH for real time updates with #RuralHealth as the hash tag.

It was a long climb #Don'tJudge

It was a long climb #Don’tJudge

Assessing the Unseen Community

As a requirement for our Public Health Nursing course, BSN students who participate on the Farmworker Family Health Program conduct a “community assessment” on one of the four counties where Moultrie area farmworkers live and work. In groups of five, we set out in groups to discover what resources are available in the county, how health services are accessed, whether or not transportation is available, etc. to determine what the barriers to healthcare might be.

Yesterday my team was able to meet with two women who work for the Southern Pine Migrant Education Program. We spoke at length with the woman who runs a migrant summer camp for school-aged children of farmworkers and a Regional Recruiter — a woman who finds and meets with migrant families when they first arrive to assess the educational needs of their children. By default, she also ends up assessing many of the family’s other needs, including any health problems they may have.

We went with these women into the trailer neighborhoods where migrant workers live and were able to speak to a man who once worked as a migrant farmer, but now works in construction. He had overcome a major hardship when he first arrived in the US (“Gracia de dios,” he repeated many times) — his daughter had a severe vision problem and he was referred to a big hospital in Atlanta where services were provided to her for free. Since then, he said, his family had experienced few health problems in the 13 years they’d lived in the US. We spoke with him for the better part of an hour, explaining that we hoped to learn more about the community and possibly offer ideas for improving healthcare services to farmworkers. Then he and his son let us feed maiz to the two pet sheep he kept penned up in the yard beside his mobile home.

We also visited with a woman who had the day off of work from the packing sheds. Her trailer home was small but impeccably clean, especially considering that she was caring for eight children under the age of seven — a rotation worked out by the women at the packing sheds to reduce childcare costs. I made a mental note to remind myself of this woman’s workload the next time I complain about having too much homework on the weekend. She told us many interesting things about the health of the children in the community: there are a lot of allergies and asthma, and they tend to get worse at times when the parents’ hours in the fields are longer, or just after major pesticide sprays take place. She also noted that colds and viruses are hard to keep under control in the children, because everyone lives in close quarters. At the same time, she was forthcoming about her opinions on high diabetes rates within the population. “We have plenty of grocery stores and access to fruits and vegetables,” she said in Spanish. “It’s just la cultura — the culture — to eat few vegetables and more starch.”

Perhaps the best thing about my experience speaking to these two members of the immigrant community was the opportunity it gave me to confront my own stereotypes and biases. The gentleman we spoke with was exactly that — a gentle, kind man who loved his family and was grateful for all that he has been able to achieve in the US. I suppose I expected more machismo and weariness of outsiders on his part. The woman was so well-spoken and aware of her situation in life — clearly, as she cares for the children of the neighborhood, she considers how things like dietary choices and pesticide exposure pose a threat to their development. I had to kick myself for thinking that just because she doesn’t speak English well (though she is taking classes) and has a lot of diapers to change, she wouldn’t think of things in a complex way. It’s hard to put into words the feeling I had visiting these two families’ homes, but it changed the way I think about migrant farmers.

I think when we provide service to vulnerable populations, we run the risk of creating a hierarchy or caste system — we are the knowledgeable healthcare providers, and they are the sad, downtrodden people who need our help. The migrant farmworkers I have encountered on this trip are not lesser beings. They don’t need my pity and they certainly don’t need a bunch of kids from an affluent school in the city to teach them how to take care of themselves. Really, all they need is access to quality healthcare. Which they don’t have, because they are undocumented workers. In the future, I hope to do more as a nurse to advocate for access to insurance and services for underserved populations. But it was enough for the day to simply understand that the best way to find out what services people need is to ask them — in person.

The ABSNs have arrived in St. Thomas!

Leave Atlanta at 2:30PM; arrive in St. Thomas at 9:15PM.  That was the plan, anyway.  After sitting at the gate (on the plane) for over an hour and a half, the plane’s radio was repaired and we were ready!  Just after the announcement to “prepare for takeoff,” we were informed that the radio was broken (again!) and we would be leaving the next morning.  After riding on the Miami airport train to two different customer service desks and waiting an additional 2 hours, we received hotel and meal vouchers. We stayed in Miami overnight and departed the next day for St. Thomas.  More quality time with my classmates!

Waiting for hotel vouchers in the Miami airport. Kelly Jones, Mary Macon Price, Rachel Koontz, Holly Smith, Christina Winters

Waiting for hotel vouchers in the Miami airport. Kelly Jones, Mary Macon Price, Rachel Koontz, Holly Smith, Christina Winters

It was all worth it when we arrived at St. Thomas and were met with breath taking views, cool breezes,  and an afternoon at the beach!

Arrived in St. Thomas to meet our immersion faculty. Dr. Phyllis Wright, Annie Rowland, Mackenzie Mancini, Mary Macon Price, Holly Smith, Rachel Koontz, Kelly Jones, Christina Winters, Eyelle Sacher

Arrived in St. Thomas to meet our immersion faculty. Dr. Phyllis Wright, Annie Rowland, Mackenzie Mancini, Mary Macon Price, Holly Smith, Rachel Koontz, Kelly Jones, Christina Winters, Eyelle Sacher

As with most places, there is a big difference in the tourist area and what the locals call home.  For the first week of this experience, one group will be working with the Federally Qualified Health Center.  They have been shadowing providers and seeing patients along with developing a patient satisfaction survey.  My group has been tasked with working on educational materials for the only endocrinologist on the island, Dr. Barzey.  She is a passionate clinician who has taught us so much about island culture and the unique challenges she faces as a provider here.  She took us to local restaurants and food trucks as we survey the locals and observe what they eat and how they perceive their own health.  We are on a mission to develop quality, culturally relevant information about nutrition and activity to help fight the obesity on St. Thomas.

Menu at one of the local "food vans"

Menu at one of the local “food vans”

Dr. Barzey talks to the vendor while Mackenzie Mancini and Mary Macon Price have a taste of local drinks- a combination of fruit juice and spices that the St. Thomians drink like soda.

Dr. Barzey talks to the vendor while Mackenzie Mancini and Mary Macon Price have a taste of local drinks- a combination of fruit juice and spices that the St. Thomians drink like soda.

Christina Winters helps Dr. Barzey take photos for her educational materials and website.

Christina Winters helps Dr. Barzey take photos for her educational materials and website.

Christina and I look forward to blogging more about our experiences with Dr. Barzey and the FQHC as we learn more about the culture here and how to help these clinics improve the quality of patient care.

Intake Rocks!

Intake. I absolutely love it! 🙂 I do not know Spanish but I love doing my best to communicate with the men while taking their histories and learning more about their needs. I have had the opportunity to work Intake a total of 4 nights! I still struggle with communicating in Spanish, but it is becoming easier every day. And even though I am not a Spanish speaker I can tell that many of our patients appreciate the effort!

One of the reasons I absolutely love intake is that I have the opportunity to speak with so many people! Through manning the intake table I’ve had the wonderful opportunity to hear about so many incredible stories. Our patients have conquered insurmountable odds just to be in the United States. Many have left behind loved one for the chance at a better life. I am continually impressed with these men and their motivation and sacrifice. I will never forget this experience and how it has impacted the way I see the world. <3

Emory Nursing Students Andrea Barrington, Laura Garcia, Bryonna Tucker, and Nicole Makris pose for a picture while working at the night camp.  Photo by Foster Baah

Emory Nursing Students Andrea Barrington, Laura Garcia, Bryonna Tucker, and Nicole Makris pose for a picture while working at the night camp.
Photo by Foster Baah

Height, Weight & BMI – Day 6

     Today, Monday June 10, 2013, is our sixth day at our clinical sites in Moultrie, Ga. Today was both very busy and productive!  My objective for the day was to assist the nurse practitioner students with their women’s health exams. I awoke this morning with a wide smile and great energy knowing that I would be providing service to women at the Las Vegas camp site. In the future I plan on specializing in nurse- midwifery and women’s health, so it is my pleasure whenever I get the opportunity to discuss the wide variety of topics centered on women’s reproductive health. However, when we arrived at the camp at 8a.m. this morning, the patients had already disbursed to their working fields, which caused a delay in our work schedules.

    Later that night we returned to the Las Vegas camp to provide services that would consist of checking blood pressure, and providing hemoglobin screenings to the male farm workers. I occupied the Height, Weight & BMI station. For the patients with a BMI of 25 or greater I taught them the importance of eating a lot of fruits and vegetables. Furthermore, what surprised me the most was that many of my patients expressed their constant desire for Coke and other types of soda to quench their thirst.  Many did not know that soda may be the cause of their constant thirst; therefore, I educated them about the health benefits of drinking water instead of soda.

     While healthy eating is a major factor for maintaining a healthy weight, it is important to recognize the available food resources for this population. Many farm workers cannot adequately afford foods to meet their nutritional demands; thus, it is critical and very  beneficial to recognize their socioeconomic status and explain to them not only how that affects their food decision process, but how to improve it as well.

 

Hard Work in Moultrie

As nursing students, we spent the three weeks prior to our journey down to Moultrie learning about community and public health. There is so much to learn about these topics, and I found them exciting because I enjoy looking at things from a “big picture” perspective. But one of the things that rarely gets mentioned about trips like this — situations in which students are providing care and learning about cultural barriers, health disparities, and social determinants of health — are the nitty gritty, day-to-day nursing tasks we perform. For me, a big picture thinker, work like this is so imperative to becoming a professional nurse. It might seem simple, but it’s important for me to remember that if I hope to work in a resource-poor setting in the future, I have to know how to take a manual blood pressure accurately — there might not be a fancy machine around to do it for me. I need to have a solid understanding of how a child’s BMI differs from that of an adult’s. I have to understand the implications of a low Hemoglobin reading, and what I can tell a patient that I may only encounter once what he can do about it.

The work we do — the actual nursing skills we implement every morning at the elementary school and every night at the farmworker camps — are such a formative part of this experience. Every day, we find ways to be resourceful. If something doesn’t make it into the van and get transported to the camp, we make do. If we run out of the type of lancet we were trained with, we put aside our apprehension about using a new kind. I think the opportunity to implement these basic skills in this chaotic environment helps to prepare me for any kind of high pressure, high stress situation I might encounter as a nurse.

Here’s a few photos of our team at work in Moultrie:

1.Lexie-Wagoner

Taking a child’s blood pressure is harder than Lexie Wagoner makes it look.

Becca Owings checks to make sure her case load of kids has visited each of the screening stations.

Becca Owings checks to make sure her case load of kids has visited each of the screening stations.

3.-NP-lungs

An NP student listens to a patient’s lungs.

A patient's sample is placed onto a glucometer.

A patient’s sample is placed onto a glucometer.

A patient's finger is bandaged after testing for hemoglobin and glucose levels.

A patient’s finger is bandaged after testing for hemoglobin and glucose levels.

Grace Cho records a patient's vital signs.

Grace Cho records a patient’s vital signs.

NP student Bettina Johnson checks her paperwork. And then checks it again.

NP student Bettina Johnson checks her paperwork.

A pharmacy faculty member coordinates patient care.

A pharmacy faculty member coordinates patient care.

A student assesses a patient's foot.

A student assesses a patient’s foot.

Huong Nguyen draws blood for a hemoglobin test.

Huong Nguyen draws blood for a hemoglobin test.

Photos by Laura Garcia, Becca Owings, and Nicole Makris

Reflection before we go: ABSN Dominican Republic

Tomorrow morning we will begin our journey to San Francisco de Macoris, Dominican Republic as part of a Quality and Safety Improvement Project. In preparation for this journey, our group of 8 students obtained $390 worth of funds through hosting a “Kid’s Day” fundraiser and through donations of our families in order to purchase medical supplies for Hospital de San Vincente de Paul. This morning we met at the nursing school and divided up the supplies into all of our suitcases. These supplies included, but were not limited to, infant stethoscopes, a newborn blood pressure kit, pediatric resuscitation equipment, surgical drapes and gowns, surgical instruments, vaginal speculums, prenatal vitamins, tylenol, baby blankets, pacifiers, preemie diapers, and sterile gloves.

For our Quality Improvement project, we will be talking with members of Proyecto ADAMES, an organization that formed to address maternal and infant mortality in their community. We will be speaking (in Spanish!) to nurses at the hospital, community leaders in the surrounding barrios, and people at the university.

Dominican Republic is a country in the Carribbean that shares the island of Hispanola with Haiti. Approximately 9 million people live in Dominican Republic, with over half living under the national poverty line (Foster, et al, 2010). As with many lower-income countries, Dominican Republic is marked with financial inequalities as the poorest half of the country owns less than one-fifth the GDP and the richest 10% own two-fifths the total GDP (Foster, et al., 2010). Although 97% of all births occur within a hospital, there is a high rate of maternal (150-160 deaths/100,000) and infant (22 deaths/100,000) mortality (Foster, et al., 2010). While this rate is much lower than that of other “developing countries,” hospitalized births with skilled birth attendants are not the norm in other countries, as it is in Dominican Republic. Therefore, a need exists to improve quality care.

Foster, J., Burgos, R., Tejada, C., Caceres, R., Altamonte, A., Perez, L., Noboa, F. (2010). A community-based participatory research approach to explore community perceptions of the quality of maternal-newborn health services in Dominican Republic. Midwifery, 26, 504-511.

 

St. Thomas here we come!

 

Hello!

Since I am new to the blogging world, I wanted to post a little “test blog!” Our group will be heading to the beautiful island of St. Thomas tomorrow afternoon, and we are beyond thrilled! I look forward to sharing our adventures with you all 🙂

Best,

Christina

map2

 

Rain, rain, rain…..

Day 3 of night camp started off more organized for most of us than the first two nights. We were more comfortable in our roles and had a better idea of what to expect at the camps. Even with the language barrier, Intake seemed to flow for me on this particular evening. We were having a great time! Ann Connor was leading a group in song while Caroline Kennedy played harmonica. All was going as well as could be expected, and then I felt it. A rain drop. One drop….then two….then ten….. I was standing near Maeve Howett when I looked at her and she yelled “RAIN!”. As quickly as the rain started, we all grabbed equipment and began loading the van. I have never seen a group move so fast and work so methodically. We had just met each other less than 72 hours earlier and we were already pros.

Even despite the rain, the evening was incredible. The men we were able to see this evening were incredibly grateful. But honestly, I felt like I was receiving more from them than we were able to provide. It was discouraging having to turn some men away due to rain. But knowing we would be back at the same camp next week helped alleviate some of the guilt.

Students dry their folding chairs in the hall of the Hampton Inn after a wet night at camp.

Students dry their folding chairs in the hall of the Hampton Inn after a wet night at camp.

Intentional Comfort Touch- Day 3

     If every child had a mother to hug, a hand to touch, a smile to give, and a kiss to receive; would their lives be blissful? I pondered about this as I sat and waited for my next patient to arrive. Today is Wednesday, June 5th my third day working in Moultrie, Ga. with migrant farm workers and their families. My objective for the day was to provide healing foot care to the farm workers, in which I was very excited to provide. As I sat and pondered, a young man by the age of 31 sat in front of me looking eager to get his feet cared for. Well equipped and prepared with a basin of Epsom salt water near my feet, I said, “sentarse y relajarse”. I allowed him to soak his feet in the water for a few minutes and then propped his feet on my lap and proceeded to examine them. As soon as I touched his feet the biggest smile lit up across his face. It was as if he’d never been touched before! I washed and scrubbed the dead skin off of his feet and gently rinsed them. Next, I moisturized and massaged his feet while explaining to him the importance of keeping his feet clean and dry. The look of pure pleasure and satisfaction was confirmed by his wide smile. The look he gave me was similar to the look that a husband gives his wife after she has prepared for him a delicious home cooked meal.  He continued to smile and couldn’t stop blushing. He stared at me with eyes of gratitude and admiration throughout the entire process.

     I thought to myself: if everyone had a person to hug, a hand to touch, a smile to give, and a kiss to receive, would they be in better health? Farm workers stand on their feet all hours of the day. When they do get the chance to go home, they have very little time in their schedules to care for their bodies like they should. Their wives may work on the farms with them in addition to cooking and cleaning at the house. Even though my patient was married, it is possible that his wife did not have the time to provide the care that I was able to provide for him today. The care that I was able to provide for my patient was very unique. I was able to give my patient a warm touch of physical comfort. Sometimes all it takes is a simple touch to relieve tension and stress. In the article, “A Conceptual Model of Intentional Comfort Touch”, Dr. Connor and Dr. Howett talked about the importance of intentional comfort touch while caring for patients. The application of intentional touch in the healthcare setting has many positive effects on the health of an individual. I found that intentional comfort touch was very useful for me while working with this patient because of the huge language barrier between the two of us. Verbally communicating with my patient was a big challenge for me because he only spoke Spanish. Because of the lack of verbal communication, nonverbal intentional touch was put at the forefront. Today, I learned so much about how a simple hug or touch can be so uplifting and valuable. I know now that providing comfort  for migrant farm workers is a great way to provide optimum care. I will continue to implement this action into my practice while caring for other farmers in the future.