“Like the lotus flower that is born out of mud, we must honor the darkest parts of ourselves and the most painful of our life’s experiences, because they are what allow us to birth our most beautiful self.” This quote by Debbie Ford stood out to me today as I encountered a patient that said he was “spiraling out of control” and needed help. It was very insightful working with the psychiatric registered nurse at Mercy Care, today. In order for a patient to be admitted to the behavioral health program at Mercy Care, he/she must first complete a nursing assessment to determine medical stability and readiness to receive treatment. I assisted with the nursing assessment of this particular patient getting renewed for the behavioral health program.
During this assessment, we performed a systematic review of systems, a urine drug screen, and spoke to the patient about his challenges. The patient’s willingness to start treatment showed his perseverance through adversities. Although he knew it would be challenging, he was still willing to continue treatment because he was confident that treatment was the best thing for his health. Individuals that have mental health disorders may have many painful experiences in their lives, and when they choose to seek treatment, they can begin to let those painful experience birth something beautiful. Mercy Care’s behavioral health program includes counseling and group therapy sessions, such as substance abuse and anger management groups, case management, psychiatric visits and many other resources for the patient.
Welcome to our final blog post from Courtney and
Abbie. Over the past week we have had the privilege to learn about and interact
with vulnerable populations in our backyard of Atlanta. We began on Monday by
teaming up with Catholic Charities Atlanta to learn about the refugee
resettlement process in the United States. We went to Clarkston to move in
furniture and set up an apartment for an Eritrean single mother and her five
children. On Tuesday, we went to Grady’s dialysis clinic for immigrants with
end-stage kidney disease. We were able to speak with patients about their life
stories, current medical condition and educate them about their disease and how
to manage it. On Wednesday, we went to Clarkston Community Health Center to do
patient education on colorectal screenings, help organize the clinic and price
out traditional grocery lists for refugee families to get a glimpse into their
financial situation. On Thursday, we went back to the dialysis clinic at Grady
to learn more about the dialysis process and update patient information packets
so they can better understand their disease. On our last day, we got to tour
and prepare lunch at Good Samaritan Health Center for the homeless population
Abbie’s favorite part of the entire immersion was
interacting with patients, gathering histories, doing a grocery store
assessment and updating new patient education packets. Courtney’s favorite part
of the entire immersion was exploring different parts of Atlanta and
interacting with populations with interesting stories and backgrounds.
Facts our group found most interesting/What our
group enjoyed doing:
Chronic Kidney Disease of unknown etiology(CKDu) is hypothesized to be the first chronic disease that could be caused by climate change
Learning the importance of dialysis and its process
How to work with interpreter services while still engaging with patients
Showing compassion to all because you never know what someone has gone through
Importance of establishing a therapeutic relationship
Health Care services available to the underserved population
Touring Good Samaritan Health Center and seeing all the resources they offer from their own food gardens to their fitness classes
The process of interviewing patients in general or for a research project
Hearing the life stories from the patients
Learning the history behind Ponce de Leon and how it was the street that was the divide for segregation
That’s a wrap from week 1! Thank you to our
clinical instructors and clinical partners we worked with throughout the week!
Stay tuned to read stories from our week 2 classmates!
Today I worked with a
psychiatric nurse in the behavioral health and substance abuse clinic at mercy
care. We discussed general patient care for behavioral health and substance
abuse, and we looked through the charts of patients who were referred to the clinic.
Furthermore, we saw one patient who visited the primary care clinic and was
referred to the substance abuse clinic, and performed a behavioral health
screen that was required to be in the substance abuse program. From this
experience, I learned how to screen patients for substance abuse, and help
provide them with resources based on their condition.
Later on this afternoon,
I went to a hypertension/blood pressure education class that was taught by a
nurse from the American Heart Association for patients who were diagnosed with
hypertension. In this course, patients were educated on hypertension and how to
manage it. The patients were given their own blood pressure machine, and were
taught on how to measure their pressure. The patients are required to measure
their blood pressure regularly, and report their lowest blood pressure
screening to the American Heart Association weekly. From this experience, I
learned about how to educate patients on maintaining their blood pressure
through their medications, diet, and lifestyle in a way that is sustainable and
individualized for each patient.
week Cabin Creek Clinic in West Virginia has been hosting meetings and
educational conferences in preparation for the rollout of their Medically
Assisted Treatment (MAT) program starting in July. We had the opportunity to
sit in during the meetings with staff and have been learning so much about MAT
as well as the gravity of the issue of substance abuse, specifically opioids
and opioid-related deaths in the community. West Virginia has the highest opioid-related
drug overdose deaths in the country (West Virginia Opioid Summary).
Assisted Treatment uses medication to help treat the physical symptoms of
substance abuse and addiction. For opioid addiction, the first-line treatment
is buprenorphine, also known as Suboxone. Buprenorphine is a partial-mu opioid
agonist, meaning it doesn’t produce euphoria or a “high” which helps to dull or
satisfy opioid cravings without creating a high (patients have described it as
helping them just feel normal). Buprenorphine also has naloxone (Narcan) in it,
which is an opioid antagonist (this is a medication used to treat opioid
overdoses). One of the counselors of the MAT program in Charleston, WV said
that Suboxone won’t produce a high regardless of the amount ingested.
Interestingly, Suboxone has a very high affinity for opioid receptors, even
more so than opiates, so if a person does use opioids while taking Suboxone it
will block opiates from binding to opioid receptors in the brain so a person
will not feel any of the effects of the opioids.
of the documentaries we watched with the staff was about the physiology of
addiction and the opioid epidemic in West Virginia. We learned that opioid
addiction hijacks the dopamine receptors (pleasure centers of the brain) and
causes physical changes in the brain. We also had staff from the MAT program in
Charleston come out to speak about their experiences with their MAT program and
answer any questions the staff had. They shared videos of powerful patient
stories currently in treatment. It was inspiring to see how people were able to
get their lives back from opioid addiction and truly thrive.
At Cabin Creek, the
MAT program will include checking in to the clinic, taking a urine drug test to
test for buprenorphine along with any other drugs, attending group counseling
sessions, and individual counseling sessions. Group counseling sessions will
include coping skills, stress management, and more. The MAT program at Cabin
Creek center will be led by Dr. Sue Westfall and her medical assistant Denise.
I got the chance to learn from
the provider at Mercy Care-Decatur, today. I sat in on all the patient visits
to the clinic. I took vitals, discussed the careplan with the provider and
reinforced patient discharge teachings when they were leaving. This experience
helped me to understand the challenges that come with treating a homeless
patient. The homeless patient population does not always have the resources,
and sometimes the education, that is needed to address their illness. They face
many adversities that hinder their health, however, Mercy Care provides
resources to assist patients. Additionally, I noticed that many of these
patients also have mental health problems. These patients have so much trauma
that they need help to overcome. Mercy Care is a comprehensive facility that
provides behavioral health, dental, housing, and pharmaceutical services.
Having a pharmacy in-house is beneficial for the patients because they can get
their prescription refilled at zero to very low cost. Patients often wait for months
before getting their prescriptions refilled because they do not have the means
or motivation to refill their prescription. In providing care, the nurses must
educate the patients on keeping their follow-up appointments and filling their
prescription in a timely manner.
Today I was at the Mercy Care
Chamblee Clinic which serves a large Hispanic population. We began the day with
a morning huddle and everyone dispersed to work on their own projects for the
day. I learned about the services provided that ranged from vaccines to patient
education. I saw how the scope of the RN is different in the public health
setting and that a lot of clinical work is delegated to the medical assistants.
We saw patients being triaged but ultimately sent the ER because the lack of
resources from the clinic. One of the nurses was calling patients to check in
on them in regards to their blood pressure readings for the American Heart
Association BP program. The level of bilingualism the clinic maintains is very
impressive and the medical staff is very competent with the limited resources
available. Mercy Care Chamblee is unique and has housing services for the
elderly and disabled right across the street which is pictured below. The staff
make it their priority to make sure all the patients are treated with respect
regardless of any socio economic or language barriers. This clinic is truly
admirable for their dedication to their patients and bond they have as a staff
PS: Mercy Care
cares for EVERYONE… literally pictured as our classmate Kayla was given two
stray kittens after her shift to take to the animal shelter and provide a safe
The Emory School of
Nursing’s neighbor across the street, the Centers for Disease Control, reports that
West Virginia has the highest rate of drug overdoses in the country. Opioid-related
deaths in 2017 was nearly
50 per 100,000 people, up 14% from the previous year. This epidemic has touched
nearly every patient I have seen at the New River Clinic either directly or
indirectly. I love podcasts, so to get the rundown on the history of the Opioid Epidemic before
it came to West Virginia, I listened to Throughline’s podcast from April 4th,
2019 called America’s
Opioid Epidemic and The Uncertain Hour’s third season: Inside
America’s Drug War. Historically, so much of West Virginia’s industry has
been comprised of very physically demanding, but poorly compensated work.
Staying home to heal was not a possibility for many, and painkillers,
particularly opioids, helped many people working people keep the lights on and
food on the table. They trusted their healthcare providers to do no harm, and
we failed them.
In true grassroots
fashion, the Fayetteville Health Department has created an innovative program
to help reduce the harm of this epidemic through a program comprised of
dedicated staff, both paid, and volunteer. On Wednesdays from 1-4, people are
able to turn in used needles and receive the same number of clean needles (30
needles max) in return. In addition, the program provides wrap-around health
and social services. Health services include Hepatitis and HIV screening,
vaccines and wound care. They also
provide birth control counseling and LARC placement. The social services they
provide include help with obtaining an ID, health insurance, housing, and food.
Patients trade in their dirty needles for clean with an addiction coach. Coaches
are others who are recovering addicts and can use their own experiences to help
steer others towards recovery. Coaches provide patients with clean needles, but
also dispense other supplies like alcohol pads, cotton balls (used for
filters), tourniquets and “cookers” to help avoid spreading infection. These supplies are
important because hepatitis can live on a surface for 14 days and is not killed
by the small flame used to “cook” IV drugs. Narcan is also given out to
patients, and patients are educated on West Virginia’s Good
Samaritan Law that allows drug users to give Narcan and call 911 without
fear of being arrested for drug possession.
Cliff Massy is the main addiction coach and the
coordinator for the Harm Reduction and Quick Response Teams. Massy is kinda a
big deal ‘round these parts. In 2017 1 on 1 Films, a
documentary production company based out of Ithaca, New York made a short film
called Out of Pills, which has won
a bunch of awards in the short film circuit. As Quick Response Team coordinator, he or someone
in his team follow up with everyone who overdoses within 48 hours, as people
are more open to recovery programs during this time. If recovery is not of
interest, they can at least be connected with the Health Department program for
harm reduction services. The health department is currently writing grants for
a new program called Engage. This would provide clean needles and harm
reduction services and education at local emergency rooms where many
underserved people receive their primary care.
The Public Health
Department the building seems innocuous, newly painted in fuchsia and lavender,
but it is surrounded by the Police Department, County Sheriff, Fayette County
Court, and Judge’s office. This location is obviously not ideal for illegal
drug users looking to access care.
Anita Stewart is a DO who
helps head up the harm reduction program. We talked about the importance of
community (particularly law enforcement) buy-in to ensure sustainability in the
program. Sometimes this buy-in comes with compromise. For example, While the
health department takes in more dirty needles than they give out (as measured
by weight) there is still minimal support for giving out more than 30 needles
because of fears that that will increase the number of discarded needles in
public areas. Similarly, the police have an agreement with the public health
department that they will not arrest people at the clinic, or after receiving care
there. Last month, however, the police recently broke this agreement, arresting
a patient who had a minor parole violation. The number of patients at the
clinic plummeted and are only just starting to rise again. The clinic is hoping
to have more sites to serve a wider population with sites away from the police.
However, while Anita Stewart says that it can be hard to “play nice in the
sandbox,” there has been greater acceptance among its critics as the program
becomes more established. She says that when people are skeptical about harm
reduction, she invites them to volunteer and see the wide range of people who
have become dependent on opioids. She says that type one diabetics, nurses, and
other people who have a greater comfort with needles seem more likely to become
IV drug users. Stewart also stresses the importance of healthcare providers
using their professional privilege for advocating harm reduction among
stigmatized populations. “After all,” she says, “many of these people got
hooked on opioids through legal medical prescriptions, we did this to
Needle exchange can be a controversial
issue, and until
2016 federal funding could not go to these kinds of programs. These
programs are still illegal in 15
states, but while stigma still remains, needle exchange programs are slowly
gaining popularity across the country because they work. Not only have decades
of studies shown that they reduce the spread of blood-borne diseases and the
number of needles in public spaces, they also can help connect people to
treatment when they are ready. Because of the increase in opiate-related
incarceration around the country, another controversial program is gaining
momentum in WV and across the country, called the Law Enforcement Assistance
program. It allows public safety officials to work with behavioral
health providers by diverting low-level drug offenders away from jail time and
towards treatment and support services.
Today, I went with the Mercy Care CHOP team to serve the homeless community by aiding to provide nursing services and housing resources. We went to Central Presbyterian Church to do this and sat in a room where patients could sign up and then visit us and utilize our services. Today, we saw 3 different patients. We took their blood pressure, and provided them with housing resources, food resources, and we gave them information about the Mercy Care clinic closest to them so that they could seek out healthcare.
One thing I learned from this experience was the different resources that Central Presbyterian Church for homeless individuals. I learned that they provide ID’s, birth certificates, resume assistance, and job resources. Additionally, they had an art studio for individuals to do art work, which I loved to see.
second day in West Virginia was just as great as the first! Jean graciously
prepared us a delicious home-cooked breakfast, so I was fueled up for a busy
day at clinic. This week, I’m rotating at Riverside School Based Health Center,
which is part of the Cabin Creek Health System. Cabin Creek Health System is a
federally qualified health center that provides high quality comprehensive
primary care to residents throughout Kanawha County, WV. My wonderful preceptor
is Dr. Jessica McColley, a family medicine DO who completed a fellowship in maternal
child health (her background is perfectly aligned with my dual FNP/midwifery focus).
As it turns out, Dr. McColley completed her fellowship at the same clinic in
Chicago where I completed an AmeriCorps program back in 2012 — we were in the
same place at the same time and had never met. What a small world!
the morning session we saw a wide variety of patients, from well child visits
to colposcopies to dental abscesses. In the afternoon, I had the opportunity to
participate in a health professional mentorship program for recent high school
graduates who are interested in pursuing careers in healthcare. One provider
presented on the liver and hepatitis, and Dr. McColley presented on sexual
health. The opening activity consisted of crafting the internal female
reproductive organs from pipe cleaners – what fun! We then played a jeopardy
game with categories including contraception, let’s talk about sex, and
consent. The participants had a great time and we all learned a lot! I really
enjoyed the opportunity to observe medical providers engage in community-based
activities outside of the clinical setting.
first two days have been an incredible learning experience. I feel like I’m
truly experiencing family medicine here. Many visits have included several
family members receiving care from the same provider. I’ve seen patients for the
management of chronic conditions, well care, sick visits and family planning.
This is my first rotation with a DO, and I have had the opportunity to observe
osteopathic manipulation for vertigo and musculoskeletal pain. The support
staff have been so kind, helpful, and a lot of fun. I’m looking forward to
continuing to learn from the wonderful preceptors and staff here and enjoying
the beautiful West Virginia mountains. I also can’t wait for our whitewater
rafting trip on Saturday!
From Cabin Creek Health Center in Dawes, West Virginia
the privilege of joining a meeting that was focused on implementing research
initiatives in primary care organized by a group of collaborating providers
from clinics in various counties. This
group was called WVACHS which stands for West Virginia Alliance for Creative
Health Solutions and the preceptor I worked with was the nurse practitioner
representative from her clinic. Her
proposed topic was on water quality and its impact on health of individuals in
the community. The group spent the
meeting brainstorming topics to implement and develop a white paper to submit
for publishing. The most popular and
decided on topic was barriers to accessing opioid addiction treatment and
implementation of MAT, which is Medication Assisted Treatment, for management
options. This topic proved to be most
popular and pertinent to the population in West Virginia given the epidemic of
opioid addiction and deaths from overdose.
It was quite inspiring to see the impact of research outside of the
academic setting and the impact it can have on quality improvement in clinics
and in the care provided to patients.
This group of interdisciplinary providers recognized a need for change
of practice and patients’ needs that weren’t being addressed and were not
sitting idly by. It was valuable to
experience the discussion about the topic of choice and witness the process
behind recognizing a health-related need and working towards a plan to address
plan to attend a MAT group therapy session later in the week to experience the
process patients endure when adhering to this treatment plan. This will hopefully shed some light on the
need for this treatment plan and how successful it can be in addressing the
patient need when properly executed.
process of integrating evidence-based practice into a clinical setting caused
me to reflect about some of the clinical guidelines or processes that are
implemented and if they truly are patient centered, proven to be effective and
produce successful outcomes.
Experiences like this are chances for professional growth and
development as I am coming into a provider role and will soon have to make
evidence-based decisions, nevertheless, have a chance to change protocol and
implement innovative guidelines.