Archive for emorynursing

Moultrie Summer Immersion Trip Week 2: Morning grind and starry night

Let me paint the picture of where I called home for a week. In the heart of south Georgia is Moultrie, population size around 15,000 people. For a birds eye view comparison, Atlanta has about 33 times that population. The paved roads are lightly sprinkled with dust and the buildings are slightly rundown. However, the energy and spirit of the children and farmworkers starkly contrast their surroundings. This experience provides a unique opportunity to work alongside interdisciplinary practices such as pharmacy, dental, physical therapy, and mental health students from schools across Georgia. Morning camp involved performing routine screenings on school children, and night camp involved screenings for farmworkers in a field or nearby local break station. We served as an extension with the local clinic to provide healthcare services.

At 8:30 AM, we drove less than 10 minutes away from our hotel to the local elementary school where as a collective unit, we provided child approved physical therapy exercises/activities, blood pressure and hemoglobin screenings, hearing and vision testing, dental care, and a final visit with a NP-S. As kids started lining up to be partnered with a NP student, we were making final adjustments to our booths to make them kid friendly. We practiced a handful of rarely used skills such as a fundoscopic exam that is usually deferred in my previous clinics to ophthalmology/optometry. My most memorable kid was a 4th grader who was held back a few grades. After completing my exam, I stood up to walk her back to the front when I looked down and saw her frustration as she was sounding out words in her coloring book. I could tell she was upset and looked up at me. Two thoughts came to mind, I could either walk her back up front and grab another kid, or I could sit back down and help her sound out the words. I sat back down and we practiced her reading skills. I didn’t know how many hours she had at home with her family to improve her reading, but I knew I could give her an additional 5 minutes of my time to get through that 5 sentence paragraph. My pediatric professor gave us advice when we encounter kids for screenings. More often than most, kids don’t come to the doctor’s office unless they are sick. She noted that when you do see them, use your time with them and be that point person to lead discussions and start education early. I wanted to ensure that the time that I shared with them was spent treating that experience as an opportunity for steps towards success.

As a NP student, consulting pharmacy and PT has been a saving grace. Instead of placing a referral into the system and questioning if the patient will even go or be contacted, I can walk 40 feet away from my station to access their expertise within the same field, pun intended. The opportunity to work with interdisciplinary specialties strengthened my critical thinking skills and sharpened my plan of care. For example, I diagnosed a patient with tinea cruris and unfortunately, we did not have ivermectin on hand. I consulted pharmacy and came up with a game plan of starting them on clotrimazole cream and gold bond with emphasis on counseling them on educational points for prevention. At the end of the day, would this treatment plan mirror what I would do in a private primary care setting? Probably not. I would have access to a chain pharmacy that supplied the oral medication and I would have the patient send me a telephone encounter letting me know if the treatment worked or failed as part of continuity of care. Working in this environment of this magnitude allows me to be more thoughtful about the present and knowing that whatever I tell this patient in the here and now, will be my first and last contact of care. Knowing the weight that this carries and understanding that we may be the only healthcare opportunity for some of these farmworkers in the US, buys into the vision that our team makes a difference.

Photos of the Trip with captions

Watermelon Sugar high before starting night camp featuring the generosity of the farm workers and our Pediatric Nurse Practitioner Students at night camp
Late night podiatry practice and hygiene counseling with the farm workers
No filter needed
NP students pregaming before night camp
Night camp tent set up; the preview before the big storm

UGA Pharmacy prepping for the night ahead
Emory MN students manning the triaging stations
Group photo taken at the end of week 2 featuring all students, faculty, and translators

Kingston Spring Immersion

EDITOR’S NOTE: The 2020 immersion took place earlier this year before social distancing, travel restrictions and shelter-in-place orders were enacted to combat the COVID-19 pandemic.

Rewarding (adj.)- affording satisfaction, valuable experience, or the like; worthwhile.

Our first couple of days at the Missionaries of the Poor was eye-opening in many regards. Despite living conditions and often failing health, the residents maintained a happy disposition and greeted us as if we were long-time friends.

To see the emotional uplift of the residents as soon as we entered the room was instant gratification. Our hearts were full as we provided basic care such as dressing, feeding and moisturizing the residents. The women were overjoyed as we painted their nails in an array of colors while the children were ecstatic to engage in playful banter and simply being held.

While the purpose of our trip is to conduct assessments on residents and aid the Brothers and Sisters of the ministry, perhaps our greatest responsibility and greatest reward is to surrender ourselves and our typical ways of life to be one with the Brothers, Sisters, and residents.

We ate as they ate, prayed as they prayed, and although most of us are not Catholic we respected their customs and truly immersed ourselves into the experience.

Jamaica itself is beautiful in many ways from the delectable food with flavors that dance on your tongue to the abundant mango trees and palms. Though the city of Kingston is impoverished, it is adorned by its beautiful mountains and unrelenting sunshine.

The days are long but each day as we turn in, we look forward to the experiences tomorrow will bring.

-Jasmine Jones

Mercy Care Clinic – Summer Immersion Trip

by Kishauna Reid

“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.

Grady Memorial Hospital – Summer Immersion Week 1

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 in Atlanta.

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!

Mercy Care – Summer Immersion Trip

by Kayla Ortiz

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.

West Virginia – Summer Immersion Trip

by Leslie Burger, BSN RN

This 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).

Medically 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.

One 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.

Here’s a FAQ page about MAT from the Cabin Creek Website: https://cabincreekhealth.com/medication-assisted-treatment/

Here’s the video from PBS that we watched at the clinic about the physiology of addiction. The documentary specifically discusses opioid abuse in West Virginia.

References

West Virginia Opioid Summary. (2019). Retrieved from: https://www.drugabuse.gov/opioid-summaries-by-state/west-virginia-opioid-summary

Mercy Care – Summer Immersion Trip

by Kishauna Reid

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.   

Mercy Care – Day 2 Summer Immersion Trip

By Rika Win

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 unit.

Mercy Care Housing

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 home.

West Virginia – Day 3 Summer Immersion Trip

by Lilah Crews-Pless

Harm Reduction

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. 

An industrial size sharps container used in the harm reduction clinic

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. 

Fayetteville Health Department

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 them.” 

Cliff Massy and Anita Stewart pictured discussing the Engage Initiative in Cliff’s coaching office. The initiative would provide clean needles and harm reduction services at local emergency rooms.
Cliff Massy (holding a vaporizer) and Anita Stewart pictured in front of Massy’s office. 

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 Diversion (LEAD) 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.

Mercy Care – Day 4 Summer Immersion Trip

by Kayla Ortiz

6/13/19

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.