Archive for Atlanta

Clinical Experience in Emory Midtown Hospital

Xiqin Huang, BSN Junior, BUNDLE Scholar

My name is Xiqin Huang, and I am a junior BSN student in the Emory School of Nursing. I am from Queens, New York.

The clinical rotation is very important component in the nursing education, because it can integrate your knowledge from lectures into real life settings. I had my medical/surgical clinical rotation in Emory Midtown Hospital for past 2 months, and it was a great experience.

My unit is an extremely busy because there are 50 beds with 10 nurses and 5 nurse techs. Also, in this unit, we had a great variety of patients such as COPD, HIV, pressure ulcers etc. During this clinical, I was able to see many diseases processes and nursing interventions that were described my textbooks. Usually, each student is assigned to one patient for the whole clinical rotation and paired up with that patient’s primary nurse. In 1st week in the hospital, I had a fabulous, wonderful nurse who really took her time to welcome and teach me. She asked me to explain all the medication to her. Also, she brought me to watch procedures on other patients that I wasn’t assigned so that I could get to experience new things.

Moreover, in this clinical, I was able to give different medications through different routes such oral, IV, G-tube etc. It was a wonderful learning opportunity to get more exposures in real hospital setting instead of reading books and watching videos. In my very last clinical shift, I was able to observe my patient’s surgical procedure, craniotomy. It is the surgical removal of part of the bone from the skull to expose the brain. And I saw other different types of nurses in operating room. A scrub nurse prepares the operating area by laying out the necessary instruments and equipment. Before each procedure, nurses thoroughly disinfect their hands and arms and then putting on sterile clothing. Under the direction of the surgeon, scrub nurses handle instruments, assist with procedures, and monitor the patient throughout the operation.

Overall, it was a wonderful experience for me in the nursing school, and it made me to become more interested in nursing field.

A Year Worth of Clinical

Isai Flores, BSN Junior, BUNDLES Scholar

The night before clinical I could not sleep from excitement. Filled with nervousness and anxiousness, I tossed and turned in my bed unaware that the morning was quickly approaching. I had organized everything I needed prior to going to bed. I neatly folded my scrubs and placed them on top of my dresser. I imagined how it would feel to finally be in the hospital in my uniform. I felt proud about all the skills that I had learned in the classroom. However, I also knew that I would not perform my skills on mannequins but rather on living people. I did not have the luxury of getting a second opportunity to perform the given skill. When I woke up in the morning, I put that anxiety behind me and pushed forward knowing I was prepared. I put my scrubs on, double-checked if I had packed everything and headed out the door anticipating my first footsteps in the hospital. I expected to see a wide array of patients – each unique with different health concerns and with different plans of care. I yearned to see how nursing theory translated into practice.

Turning left off of Ponce de Leon Drive, I saw the sign: Emory University Midtown Hospital. I was ready to enter the hospital and arrive at Unit 31. The culture of the unit could be summed up in one word: inviting. This was my first semester in nursing school.  They were very open to us even though we were students with very limited knowledge. I think by the end of that semester I had mastered the art of the bed bath. During that first rotation, I shadowed a nurse who had worked on that same unit for thirty years. She encouraged me to speak to the patients and ask her questions about anything I noticed. I asked her about how she schedules her day, how she chooses what assessments to perform on the patients, and so many other questions. She answered every single question with eagerness, willing to share her knowledge.

***

Second semester, so far had been fantastic. Population health and pediatrics were the best moments of my clinical experience. Waking up the morning of my first day of population health clinical, I knew I would be greeted by familiarity. First, because I had spent time at Mommy & Me for service learning last semester. Secondly because I hoped to stay with the same kids from last semester. Despite this familiarity with Mommy and Me, Clarkston was starkly unfamiliar to me. We have only a few weeks and the thought of planning a substantive intervention slightly worried me because six weeks seemed too little. I thought: how would we do this? What was the main problem that they faced? How would we help ameliorate all the health issues that this community faced daily? I knew the answer to that question already. We simply could not. At least – not in the time span that we have. However, I know that we could think of something that can, at least for the time being, address some of the health issues. At the end of my session, we made home visits to the mothers to further assess the health needs of the community. They were a source of inspiration and bounding resilience that could only be gained by personal experience. In the end, we worked on educating the mothers on health insurance and how to renew benefits for their children.

Overall I have learned that health care is so multi-faceted. The multi-dimensional approaches to health that we have taken in my clinical experience have surpassed my expectations. I look forward to next year and the future where I can learn more and achieve more.

~~~

Isai Flores is a third year student at Emory, in the school of nursing, pursing his BSN. He is a Gates Millennium Scholar and a BUNDLE Scholar.

Population health

Alex King, BSN Junior, BUNDLE Scholar

My name is Alex King, and I am a junior BSN candidate. I was born and raised in Atlanta, Georgia, and I started my college career at Georgia College and State University and transferred to Emory University for the Nell Hodgson Woodruff School of Nursing. For my community health rotation, I was fortunate enough to work with Dr. Phan at the Atlanta Housing Authority site. For this clinical rotation, we focused on identifying health disparities within the community then planned interventions accordingly. We identified social anxiety as the major health disparity among the population. We conducted a literature review and found that group therapy was very beneficial for people with social anxiety, so we decided to hold a session for them. I decided to take on the responsibility of leading this intervention. I had never conducted a group therapy session before, so I did some research and found out that the best way to conduct the group therapy session is to come up with discussion questions beforehand. I came up with “would you rather” questions such as “would you rather pause time or go back in time.” I thought that these would be fun and light way to get the ball rolling, but little did I know they would become heart-opening questions that would create new friendships. When I started the group therapy session, I was very nervous about how it would go and whether people would have a hard time opening up. Almost immediately once I started asking the would you rather questions people began opening-up. It was amazing how deep people got in answering the questions. When I asked them the question about pausing time or going back in time, it allowed people to reminisce with each other about the good times they had in the past when they were younger. What I found to be even more beneficial was when they started to talk about past life events that were hard for them or things they regretted. This then created a scenario where they started to support each other. When someone said that they lost their job, it instantly created an environment where people supported that individual in realizing what a good learning experience it was. They concluded that hos job loss created a life experience that allowed him to realize that if he could overcome that, he could overcome anything. This went on for more than an hour, and I ended up having to stop the session because it went over time. I would have never dreamed of this hour group therapy session being so productive, especially with having no experience beforehand. It made me realize how productive and beneficial it is to go into a community and provide services based on the needs of the population. This has given me a taste of how awesome it is to assess a community, prioritize their health disparities, research the issue, plan outcomes, and see the results that come from these outcomes and the wonderful benefits that follow. I am so glad that I got to do my public health clinical with the AHA, my Emory Nursing peers, and Dr. Phan.

Countdown to Zero: Defeating Disease

Tyra Skinner, BSN Junior, BUNDLE Scholar

This past Saturday, I decided to take a break from studying to visit the Carter Center. I was really excited to see what the Carter Center had for me to learn and absorb but I was most excited about the Countdown to Zero: Defeating Disease exhibition. The exhibit is fairly new to Atlanta and focuses on diseases that plagued many parts of the world and tracked their journey to eradication.

There were walls full of information about guinea worm disease, malaria, small pox, polio, trachoma and a few other diseases that are currently in the process of being eliminated or eradicated. Each disease had pictures and information about prevention, methods of transmission and the manifestations of the diseases on an individual and the community. According to the Countdown to Zero: Defeating Disease brochure, guinea worm disease could become the second human disease to ever be eradicated, with smallpox being the first.

What’s so hard about eradicating a disease? Don’t you just wash your hands and use clean water? Well obviously, it’s a little more complicated than that. Scientists have been working for decades just to control or eliminate some of these diseases. Disease eradication is one of the biggest challenges to public health and there are a number of reasons why some disease cannot be eradicated.

Measles is one of the most contagious, deadly disease that we still see today and is also eradicable. Even though, vaccines are reliable and common, there has been a rise in the number of cases in recent years. Increased disapproval of vaccines and lack of economic and governmental support has led to less children receiving the measles vaccine, leading to setbacks to the eradication of measles.

One tricky part about disease eradication is that not all diseases can able to be completely wiped out of existence. For example, Influenza is a common disease that is often brought to the public’s attention around fall and spring every year. It is also a disease that does not fit the criteria for eradication. Why? There are many different strains of the disease that mutates frequently so a vaccine that worked last year may not work the next year. Trachoma, a bacterial disease that spread through eye-seeking flies, is also not eradicable but the blindness that is caused by the disease can be treated with a surgery.

A part of the exhibit that really caught my eye was an educational flipbook from South Sudan that was made from cloth instead of paper. The book didn’t have any words on it and was bound more like a scroll than an actual flipbook. The one picture that I could see illustrated the proper filtering technique that is now utilized in many villages in Africa to filter water, preventing the transmission of pathogens like the guinea worm. Villagers place a cloth with a semi-permeable section in the middle on top of a bucket and pour water over it to make the water drinkable. Cloth was used instead of paper or cardboard books because paper and cardboard are not able to withstand the conditions of the fields in the most commonly affected areas.

The Carter Center had other exhibits that focus on the many great things that Former President Jimmy Carter and his wife, Rosalynn Carter, have contributed to public health, global affairs and policy during his presidency and years after. I highly recommended checking it out, especially viewing the Countdown to Zero: Defeating Disease exhibit.

***

Tyra Skinner is a traditional BSN student at Emory’s School of Nursing. She serves as a mentor and team leader for the Health Career Academy and is also a part of the BUNDLE program.

First Week at the Atlanta VA!

Hello from the Atlanta VA Group! We have had a great start to our two week immersion experience with our Veterans! There are so many experiences to be had here at the VA, so we have been jumping in where ever we can. We started last Friday by attending an M, M and I meeting (Morbidity, Mortality, and Improvement). During this monthly meeting, a topic is chosen and a case within that topic is discussed. This month’s topic was Delirium vs. Dementia. It was so interesting to hear the experts discuss their views on something we have been discussing in class recently!

This week we started off by doing a scavenger hunt to orient ourselves with all the VA has to offer! We were able to introduce ourselves to many of the employees and volunteers that serve here. We were so impressed by the warm welcome we have received by everyone (patients, employees, volunteers, etc.). We can tell that the VA really takes pride in the amazing work that they do every day.

We have also been helping out with some research by transcribing interviews for part of a project called “Choosing Wisely” which focuses on starting a dialogue on how providers and patients can avoid unnecessary tests, treatments and procedures. As future providers, it is essential to be conscious of how we are utilizing resources while providing quality care for our patients.

Coming up next, we are excited to participate in Internal Medicine rounds and participate in another quality improvement project involving Value Stream Mapping.

St. Thomas: Photo recap of our first week!

 

Greetings from beautiful St. Thomas! Where do I even begin? We have so much to share from the past 7 days, so we decided to do a photo blog so you could experience it with us!

As Holly mentioned in her previous post, the eight of us were split up for the first week (1/2 with Dr. Barzey, 1/2 at the FQHC). The lovely staff at the FQHC welcomed us with a sweet sign 🙂 Annie, Rachel, Eyelle, and Kelly have been working hard to distribute ambulatory care surveys, creating educational materials for patients, shadowing the providers, and making the health center more patient friendly.

Rachel, Eyelle, Annie  & Kelly at the FQHC

Rachel, Eyelle, Annie & Kelly at the FQHC

The other group worked with Dr. Barzey (the only endocrinologist on the island)  to create a comprehensive booklet on diabetes education that she can give to her patients. We also had the chance to go out into the community and survey the locals about their nutrition and exercise choices.

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Speaking of food choices, the most popular fruit on the island are mangos! They are sold on almost every street corner, and are some of the most delicious mangos we have ever tasted!

A local fruit stand in downtown St. Thomas

A local fruit stand in downtown St. Thomas

If you don’t believe me, ask Eyelle!

Eyelle enjoying a mango!

Eyelle enjoying a mango!

Both groups worked dilligently all week to meet their goals and deadlines. We have learned so much about the culture here on the island. It is amazing how differently islanders live, and how much they appreciate the small things that we often take for granted.

The most frequent mode of transportation on the island: The "Safari" serves as a taxi to the locals. Usually less than $5 per ride!

The most frequent mode of transportation on the island: The “Safari” serves as a taxi to the locals. Usually less than $5 per ride, and can fit up to 18 people!

At the end of a long week, Dr. Wright invited us to have dinner at her and her husband’s beautiful ocean side home in St. Thomas.

The girls with Dr. Wright and her husband Chip.

The girls with Dr. Wright and her husband Chip.

Did we mention the view from Dr. Wright's front deck? (#nofilter)

Did we mention the view from Dr. Wright’s front deck? (#nofilter) p.s. that is St. John in the distance

Before we knew it, the weekend was here! We took a ferry (only $6, 10 mins) to the gorgeous island of St. John to enjoy our weekend off! Here are some pics of our trip:

St. John

Welcome to St. John!

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

The girls showing off their “Caribbean Hook Bracelets”

"Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as "island time" to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)"

“Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as “island time” to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)”

 

We had an amazing time in St. John and were sad to leave 🙁 But also excited to start another week, and this time, all eight of us were reunited at the FQHC!

Annie pausing for a smile while preparing her ambulatory care surveys!

Annie pausing for a smile while preparing her ambulatory care surveys!

Mackenzie and Christina going over some important details for their clinical day

Mackenzie and Christina going over some important details for their clinical day

Rachel and Dr. Wright at the FQHC

Rachel and Dr. Wright at the FQHC

We’ve had an incredible week so far here in the Virgin Islands, and look forward to this week’s adventures!

Nursing love,

Christina

 

 

 

 

 

Senior Year – Community Health Interventions

This past week, multiple groups of students finishing their Community Health Clinical rotations gave presentations to fellow students, faculty, and staff on the experience of working as student nurses in a Community Health setting. For many of the students, this was the first time we had worked in a larger, population-based community setting. Some of the areas represented included: The Gateway Center for homeless men and women in downtown Atlanta, Moultrie migrant farm-worker populations, the Clarkston Community Center (home to a variety of ethnicities and refugee populations), and Café 458 Restaurant for the homeless. Overall, the majority of students expressed that they had an incredibly informative, moving, and successful experience working in the community.

Student activities ranged from education with the populations, to interventions to address specific issues – such as high rates of teen pregnancy or increased rates of hypertension. Many of the main health topics and interventions focused on exercise promotion, healthy diet promotion, and prevention activities. The levels of prevention included primary, where clients were provided education; secondary, where clients were screened for different ailments; and tertiary, where clients already suffering from diseases were taught ways to decrease morbidity and mortality from their illnesses. Many of the groups were able to evaluate the effectiveness of their interventions through the use of surveys and data collection of community members’ thoughts. The prevention activities were based on the goals and objectives of Healthy People 2020, a US Department of Health and Human Services nationwide program dedicated to disease prevention and treatment. As a part of these Healthy People goals, it is especially important to reduce the disease burden in vulnerable populations – such as the homeless, minority groups, and immigrants.

One of the most common themes described by the students when reflecting on their experiences included the importance of cultural sensitivity, such as respecting cultural differences and different beliefs. Many students expressed that they learned a variety of new information about different cultures and communities that they had not previously come into contact with. Another similarity discussed among the students was the importance of recognizing the heterogeneity inside of the groups. We learned that community groups often have more intra-group variation among their individual members, as compared to inter-group variation. It quickly became apparent that members of the same community cannot necessarily be easily categorized or stereotyped into one or two broad descriptors.  In this sense, we learned the importance of breaking down barriers, such as stereotypes and assumptions about group needs and desires, in order to deliver the most culturally-relevant and appropriate care.

The feedback that students received from the Community Health Interventions was overwhelmingly positive. The majority of community participants were incredibly appreciative of our work with them in multiple areas. In addition, all of the students were mutually grateful that we were so readily accepted into these different communities. The people we worked with embraced not only our education and teaching, but also our cooperative spirit and developing sense of unity with them.

Senior Year – Topics in Class

The last semester of Senior year is somewhat hectic for most of the students. Not only are we busy keeping up with schoolwork, we’re also applying to jobs, applying to graduate programs, culminating research projects, and practicing for our NCLEX Licensure Exam. In addition, we all have two 12-hour clinical shifts per week. Needless to say, there isn’t a lot of free time! Our courses this year are geared towards bringing together all of the fundamental information we’ve learned in the previous three semesters. Senior Year courses include: Synthesis, Core Concepts: Acute Care Nursing, Community Health, Role Transition, and Professional Development: Politics and Public Policy.

Synthesis is a course that focuses on preparing Nursing Students to take the NCLEX Licensure Exam. We take practice quizzes every week on a variety of different topics, such as general Medical/Surgical care, Psychiatrics, Pediatrics, Maternal/Infant Care, and many others. Overall, we’re reviewing what areas we need to review prior to taking the NCLEX exam.

Core Concepts: Acute Care Nursing focuses on the “sickest of the sick.” Many of the patients that nurses come into contact with, especially in the hospital setting, have some type of illness. However, this course instructs students on how to care for the “acute” patients – such as those patients experiencing Hypovolemic Shock and Cardiac Instability. Thus far in the course, we’ve learned a variety of different monitoring devices for patients with Cardiac Output issues (i.e., patients whose hearts aren’t functioning/pumping effectively). In addition, we’ve also learned techniques never before discussed in Nursing School – Emergency/Disaster Nursing. We’ve covered many different subtopics under this umbrella, from care during an environmental emergency (e.g., flood or tornado), to care during biological terrorism events (e.g., Anthrax and Viral Hemorrhagic Fever).

The Community Health Nursing course addresses nursing care on a larger, population-based level. Students participate in a Community Health Clinical two days a week at a variety of different locations, working with vulnerable community groups, such as immigrants and the homeless. As mentioned in some of my previous posts, my clinical is at the Gateway Center in downtown Atlanta. This facility caters to homeless men and women in the area, and provides them with shelter, healthcare, educational opportunities, and assistance finding work.

The additional Clinical course this semester is Role Transition. This course focuses on the students’ involvement and experiences in their Role Transition/Practicum site, where they are placed based on their particular interest. Students participate in either the Community Clinical or the Role Transition Clinical for half of the semester, and then switch mid-way through. I will be finishing up my Community Health Clinical in a few more weeks, after which I will begin my Role Transition Clinical. I’m placed at the Mother-Baby/Postpartum Unit at Emory University Hospital, Midtown. During this clinical, I’ll have two 12-hour shifts to complete each week. It sounds a little hectic, but the students in Role Transition now are somehow managing to meet the requirements, so I know it’s possible!

Our last course is Professional Development: Politics and Public Policy, specifically relating to Healthcare. Because of the rising costs of healthcare, and new policies being enacted regarding healthcare, it is imperative that students become informed and aware of these changes. This course provides invaluable information to us about a variety of different topics, such as the economics of healthcare, healthcare reform, and quality improvement. In addition, we also attend some type of legislative day for this course. I attended the Georgia Nurses Association Legislative Day this past January, where I was able to speak with a variety of senators and representatives about Healthcare delivery.

This is a busy semester for virtually all of the students, but I think we’re gaining information that will be highly useful for our future careers as BSN nurses. I think one of our biggest motivators to keep working through this semester is the countdown to our graduation on May 14th!!

Senior Year – Community Health Clinical

Throughout the last semester of Nursing School, the seniors have either one of two clinicals – Community Health or Role Transition (i.e., practicum/preceptorship). After half of the semester is completed, the students switch from one to the other. For the first half of this year, I’ve been in my Community Health Clinical at the Gateway Center in downtown Atlanta. This facility serves homeless men, women, and children that have come to the Atlanta area for a variety of different reasons.

The Gateway facility is able to provide temporary shelter to these clients, but it places a special emphasis on gaining work and education. Many of the clients are enrolled in a variety of educational or treatment programs in an attempt to restore their lives and regain their independence. The initial intake area is a large, open room with a variety of clientele – all different ages, races, genders, and ethnicities. One of the first things I learned very quickly in this clinical rotation is that there is no stereotypical “face of homelessness.” Many people have preconceived notions about what a homeless man or woman looks like. However, just from working in this Center for only a few weeks, it is quite clear to me that this is not the case at all. Many of the clients we work with were once in very stable positions, but due to some unforeseen event, they have come to find themselves homeless. In fact, one of the staff members of Gateway was even a former client of the facility. Working with this population makes it quite obvious that all of us, no matter what our situation or background, are susceptible to homelessness.

During our clinical shifts at Gateway, we participate in a variety of different activities, such as educational sessions, art therapy, and health fairs. Some of the topics that the clients are most interested in include hypertension, diabetes, stress management, and heart health. We usually get a pretty good turn-out at each event, with a record set for our group of 39 participants in last week’s health fair on Heart Health (conducted by students Chelsea Pharr and Marcus Whitlow). The patients are always especially interested in finding out what their blood pressure is, ways to reduce these numbers, and information on healthy diets. I’ve been so impressed by how interactive and receptive the majority of them are with all of the students; they’re genuinely interested in hearing what health advice we can provide, and ways to improve their situations.

The nursing students at Gateway act in many different roles during the clinicals – student nurse (of course!), educator, counselor, and listener. I’ve found that the latter role, listener, is often one that the clients appreciate most. As our clinical instructors, Prof. Monica Donohue and Jordan Simcox, have informed us – many of these men and women are never even routinely called by their own name when living on the streets. So many of us get caught up in all of the busy work we have to do each day with school, friends, and family, and while this work is difficult and time-consuming, it’s important to think of populations that are quite worse off than us. Imagine living on the street and having most people avert their eyes whenever they walk past you, as if to ward off any type of conversation or pretend you aren’t even there. When a student, or anyone, sits down with any of these men or women and takes the time to talk to them, and especially listen, it truly seems to improve their outlook. Once again, the “art of listening,” that is often highlighted as a gift of nurses, serves to provide a connection with these clients that may have been missing in their lives for quite some time.