Archive for Immersion Learning

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.

Caryn’s Big Word

Ariel McKenzie, BSN Candidate 2018, BUNDLE Scholar

The encounter I had with Caryn happened at the International Bible Church in Clarkston, Georgia. My service learning group was delegated the task of encouraging language nutrition amongst refugee mothers and children as a part of the Mommy and Me family literacy program. Encouraging mothers to engage their babies and children as their conversational partners can be difficult when a language barrier already exists between the volunteer and the family. I had the privilege of working with the young toddler class and the ease with which they pick up words boggled my mind at times.

Caryn, a young toddler from Vietnam was one of the more social kids in her group. She would come into class and made sure all the volunteers saw how pretty she looked that day. She played with all the children and chatted away as she moved from station to station. The room was equipped with playing stations that included cars, blocks, a play kitchen, books, and a large box filled with treasures buried in dried black beans. There was a stipulated schedule for each day and play time was the first item on the list. When I came into class on a Thursday morning, I sat down by the cars and train playing station and began talking with the kids. On any given day, few kids even respond to my over-the-top excitement and enthusiasm, but Caryn thought it was so funny. She came and sat at the station with me and we began to play with a green bus. The bus had a Triceratops dinosaur on it and I thought it would be worth a try to see if she could pronounce the word Triceratops. I pointed to the dinosaur and said di-no-saur slowly and clearly. She repeated the word “dinosaur” with ease so I proceeded to say Tri-cer-a-tops. She sounded out the word and within minutes, she was calling every dinosaur in our bucket a Triceratops. I was shocked to say the least. Few kids even spoke to me and here was one that was sounding out a word that some elementary school kids rarely use.

Empirically knowing according to Carper’s fundamental ways of knowing involves scientific, evidenced based practice (Johns, 1995). Approaching our encounter empirically, I acquired some background knowledge through the Talk with Me Baby training that my service learning coordinator organized. Through the training, I learned the importance of engaging children as soon as they’re born as our language partners and promoting language nutrition within the family. The training provided evidenced based methods for language development in children and the results of implementing those methods as early as infancy.

In addition to applying an evidenced based approach during my interaction with Caryn, I applied Carper’s aesthetic way of knowing by grasping the nature of this specific encounter and acting according to what I believed was appropriate (Johns, 1995).  I noticed Caryn’s behavior in class and I knew she was an outgoing, eager learner. She demonstrated no intimidation while happily playing and talking to the other kids in the class. Taking into account her personal attributes, I thought that encouraging her to pronounce a word might benefit her language development. Additionally, the likelihood of Caryn trying to pronounce that word was high based on her natural curiosity.

Carper’s personal way of knowing begins with the nurse firstly knowing herself (John, 1995).  By addressing my prejudices and being willing to set any obstructive biases aside, a smoother interaction with the kids can occur. Having many close friends that came to the United States seeking a better quality of life, I knew that I was biased in Caryn’s favor. I’ve witnessed my own peers struggle to learn English and how successful they’ve been with continual effort. I know learning a second language can be challenging especially when a person is still learning new words in their native language. However, it can be done and I hope for nothing more than to see the students in the literacy program excel in their language development.

Carper’s ethical way of knowing entails differentiating right from wrong and taking appropriate action (John, 1995). After reflecting on the interaction I had with Caryn and my service learning experience in Clarkston, I conclude that the right action was taken. The families that participate in the program want to be there. They want to learn English and skills that will make their transition to living in America easier. This is why I believe encouraging them to reach their maximum potential is the right thing to do. Even though my interaction with Caryn might not seem extremely important in the grand scheme of things, it was. The satisfaction children experience when they successfully grasp a new skill is one even I remember. The least I can do is help kids experience that satisfaction while enhancing their language development.

My service learning experience in Clarkston differed from other experiences I had with people because this time I felt like I was representing something bigger than myself. Not only was I serving on behalf of Emory’s school of nursing, but I was a nurse to those kids. They didn’t know that I’m only in my first semester of nursing school. I was wearing nurse’s scrubs, so, therefore, I was a nurse. Our service learning group might have been the first nurses the kids encountered since moving here and I really wanted them to feel safe and happy around us so trust could be established instead of fear as early as possible. I’d like to think that with every human encounter that I have while I’m in uniform that I have the opportunity to increase a person’s trust in health care workers. The techniques I used to guide the conversation were building rapport, smiling, over enunciate, and offering positive reassurance. These techniques were helpful because the kids were very young and they often shy away from adults if they sense the person is unenthused. Hopefully, the program will continue to thrive and Caryn’s vocabulary will continue to grow.


References

Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22(2), 226-234. doi:10.1046/j.1365-2648.1995.22020226.x

It’s National Public Health Week (April 3rd-9th)!

Sheryl Boddu, BSN Class of 2017, BUNDLE Scholar

As a nursing student and a BUNDLE Scholar at Emory University, I come across the words “Public Health” more times than I can count on any given day. I first became acquainted with this term in my Community Health course, where it was defined as “the promotion and protection of the health of people and the communities where they live, learn, work and play.” But what does this exactly mean?  How does it play in the real-world as one’s job, duties and community outcomes?  I did not truly understand the importance of Public Health and the value its entities hold until my Capstone Clinical experience in Gainesville, Georgia.

Since February of this year, I have been learning about the duties of a Public Health Nurse (PHN) at the Department of Public Health (DPH) under the mentorship of David Donalson. As the designated PHN for District 2, David plays many roles and holds various responsibilities that I am fortunate enough to observe. On a typical day at the DPH, I learn how to answer emails and phone calls, track disease surveillance, observe emergency preparedness simulations, perform data analysis assistance and read about current guidelines and policies pertaining to Public Health matters. DPH in Gainesville particularly focuses on notifiable diseases and Sexually Transmitted Infections (STI’s), such as Chlamydia, Gonorrhea, Syphilis and HIV, because of the increasing prevalence of preventable cases. This trend has been attributed to poor access to health care, poverty, and language barriers among the underserved populations clustered in the 13 counties located in Northeast Georgia. I received first-hand experience of how Public Health officials can overcome these challenges and promote good health and well-being.

Likewise, I have been introduced to real-life examples and uses of resources and tools such as Online Analytical Statistical Information System (OASIS), State Electronic Notifiable Disease Surveillance System (SendSS) and Georgia Registry of Immunization Transactions and Services (GRITS). While these programs were just abstract ideas in my Population Health course, in the field I saw health care professionals such as Epidemiologists, Data Analysts and PHNs use them to identify patient’s trajectory and the following-step in the process of preventing disease outbreaks. What was particularly intriguing for me was learning about the expanded role of PHNs as defined by the Statute O.C.G.A. § 43-34-23. Under specific protocols, PHNs can perform screenings and physical exams, diagnose a condition, implement a plan, dispense and administer medications, and even follow-up with treatment management and symptom reduction. This allows for a broad scope of practice and application of skills and knowledge among PHNs, which is not otherwise available in the career path of Registered Nurses with a BSN.

Entering this position, I hoped to learn more about the purpose and duties of PHNs. Connecting principles that I learned in class to actual practice made me realize the importance of Public Health and led to my interest in this field. As a novice, beginning a career in healthcare, I feel more confident and prepared because of this unique experience. I look forward to tackling challenges and contributing to the future of Public Health.

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Sheryl Matthews is a senior, undergraduate student looking forward to graduation this May. In addition to pursuing a future in Public Health, she is also interested in Critical Care and graduate programs in research and innovation. She is an Oxford College continuee, BUNDLE Scholar, Student Ambassador for the School of Nursing, and the treasurer of Savera, Emory’s Indian classical and fusion dance team.

A Global Health Opportunity in Our Own Backyard

Jessica Nooriel, junior BSN student and BUNDLE scholar

In my first semester of nursing school, my volunteer hours were spent at the Friends of Refugees program called Mommy and Me in Clarkston, Georgia. In this Family Literacy program, mothers are taught ESL while their children are exposed to the English language as well through language nutrition. This intervention is based upon evidence and multiple studies, and these studies have shown that the more exposure to words a child receives in his or her first few years of life, the higher their chances of achieving literacy in his or her younger school-age years and the better chances they have of attending university and obtaining jobs later in life. So, in short, language nutrition is of utmost importance, especially for this population of refugee children who are being raised in homes in which English may not be used often.

After my first semester volunteering with this program, I had spent sufficient time in the various classrooms interacting with the children and I thought that I had a grip on what public health meant for this community. It was plain and simple. Learning the language was the most important factor in the process of these refugees becoming integrated into American society, so I thought.

This semester, my second at the nursing school, was when I began my full population health clinical. Coincidentally, I was placed at the same site as where I volunteered last semester, the Friends of Refugees Mommy and Me program. Since I had spent some time volunteering at Mommy and Me last semester, I thought I knew what to expect for my clinical portion of population health at Mommy and Me. As before, I thought I would arrive at the Clarkston refugee school, be introduced to a new class’s teacher, and then spend the morning speaking and playing with the refugee children of that class until their mothers came to retrieve them at noon.

During my second clinical day at Mommy and Me, though, all of my expectations were exceeded. This time, I felt more empowered. During our pre-clinical meeting in the morning, we discussed our roles as student nurses in this clinical—which involves responsibilities such as noticing refugee children who may have health conditions that aren’t being treated or observing community-wide health issues or gaps in knowledge. This time around at Mommy and Me, I was given a task and a tangible goal, to improve the overall health outcome of the Clarkston refuge community, whether through individual or community actions.

My morning began as I expected. I joined an older toddler classroom, where I aided with snack time, played with the children during playtime, and gave the children as much language nutrition as I could. However, after lunch, my instructor took my group to a refugee resettlement agency, New American Pathways. All we were told was that we would be helping the agency with a program they were planning. I went into this meeting with few expectations.

When I walked out of the New American Pathways building after our meeting, I felt empowered. I felt that my one year of nursing education could already be used to make a difference. The opportunity that we were asked to help with was a Women’s Sexual Health Education class for Middle Eastern and Eastern African Refugee women involved in the North American Pathways organization. My clinical group was given the responsibilities of finding reliable academic sources, creating an appropriate lesson, and fully executing the class when the day came. The education of these women now fell in our hands. And we could feel the immense responsibility that we now all had. We have just begun research on topics in women’s health, and my excitement is growing with each step in the process.

In my time at Mommy and Me, I feel that this experience will equally benefit me as it does the refugees we interact with. I will have my assumptions challenged, and I will come out a more aware and conscientious person. Since my own parents came to the United States as immigrants just two decades ago, I am gaining a better glimpse through interactions with the families at Mommy and Me, just what my parents went through on their journey toward making the United States their new home.

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Jessica Nooriel is a junior BSN student. She chose nursing for its holistic views on both preventative and curative medicine. Her passion for exploring the various health practices and beliefs of different communities and cultures drove her to join the Emory International Nursing Students Association (EISNA). She is tri-lingual in English, Farsi, and Hebrew, and hopes to use these skills for interpretative services within health care.

Graduate Immersion Experience During West Virginia Flooding

Flooded streets and businesses in Clendenin, West Virginia

Graduate students in the School of Nursing’s Nurse Practitioner program Phil Dillard (Emergency) and Abby Wetzel (Nurse-Midwifery) discuss their immersion program experience with Cabin Creek Health Systems. The students worked alongside staff of the Clendenin Clinic to evacuate medically-fragile residents during the region’s recent storms and devastating flooding. Cabin Creek is a federally-qualified health center that provides essential health services to vulnerable populations in rural West Virginia through several community-based clinics.

 

Graduate Students Reflect on Immersion Experience during West Virginia Flooding

WV_Houses

School of Nursing graduate students participate every year in a two-week immersion program in West Virginia through the Lillian Carter Center for Global Health and Social Responsibility. Our students work in partnership with area federally-qualified community health centers to promote health and prevent disease throughout the region. Led by faculty Advisors Carolyn Clevenger and Debbie Gunter, students Andrea Brubaker, Phillip Dillard, Kimberly Eggleston, Hannah Ng, Jill Peters, Allysa Rueschenberg, and Abigail Wetzel, were providing essential health services through four community clinics located in cities to the north and south of Charleston. Two of our students, Phil Dillard and Abby Wetzel, were working in a clinic in Clendenin, a town 25 miles northeast of Charleston that was hit hard by the storms.

Phil Dillard discusses the experience in this WSB-TV Channel 2 interview. WSB Interview – West Virginia Flooding

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.

D.R. Wrap-Up

Our final two days in San Francisco de Marcoris included Q.I. presentations about both programs we observed. The five of us who worked at the Hospital San Vicente de Paul, invited hospital administration, staff, and students to our presentation on the Kangaroo Care/Programa Caguro. Everyone did a wonderful job and the hospital team was very receptive to, and happy with, our observations over the two weeks. Later the same day, the second group presented to the Manhattan community and were also well received. No doubt we all learned a lot about a vastly different healthcare system than our own, and are so very grateful for our time in the D.R. Many of the people we met during our journey there will be faces remembered for the rest of our lives.

On the day before we flew back to the U.S., Dr. D gave a wonderful presentation on her research on Health and Spirituality, at the hospital. It was a big turn out! After grabbing our bags, we packed in to a minibus with fewer seats than people, and began a loooooooong, hot, squished journey to the capital, Santo Domingo. Many acres of rice fields, mountains, small towns, and farms later we arrived at the University, where we had a meeting with the new administrators about the purpose of our trip/projects.

Then piled back into the bus and drove around until we found our hostel for the night. Hostel Nomadas is a little slice of heaven in a beautiful city. We got out to do a bit of sightseeing, which included setting foot in the oldest cathedral in the New World. Amazing. Then the night ended with a lovely dinner on the rooftop of the hostel.

We all learned so much on this trip. And though it’s nice to be home, the experiences and people in the D.R. will be missed.

 

Vámonos al la playa

This weekend we had a wonderful getaway adventure. Our trusty driver, and our hostess, drove took us through the city of Nagua. Where we visited the Nagua campus of University de Santo Domingo. It was very impressive! The center is open air and feels as big as a futbol pitch.

We kept going on to Playa Grande. It was everything we’d hope it would and more: white beaches, clear water, sun, and great company. A few sunburns later, we were all ready to head to the hotel Bahia Blanca. It was a hidden gem in Río San Juan. Owned by a lovely Canadian woman, it is tucked away amongst a few small beaches. We ate dinner at an Italian restaurant in town called La Casita. With stuffed bellies, we returned to the hotel and continued the adventure on Sunday. We explored beaches and enjoyed wandering

Early morning swim

Early morning swim

around town. Then we returned to San Francisco de Macoris by bus (with air conditioning!).

This morning we all squeezed into our little red mini bus and headed out to the community of Manhattan for a health fair for the pregnant women who lived in the area. We talked about preeclampsia, baby development, and prenatal nutrition.

This afternoon a few of us went out to the countryside to enjoy an afternoon at El Rancho de Don Lulu. The bravest of us all headed up the mountain for a hike. The hiking group had some hiccups along the way, but returned safely after a few hours thanks to their trusty guide…who happens to be the pet dog of the man who usually guides people to the mountain top. He was off today but his sweet pooch made sure everyone was accounted for. Back at the ranch, the hikers cooled off in the natural spring pool there.

Tonight, we are finalizing presentations for tomorrow morning!

It’s Friday in the D.R.!

This morning we sent a few people to the hospital, while the rest of the group headed out to Manhattan’s La Casita de Salud, where a CPR training session took place. Community leaders were trained in CPR (RCP, in Spanish), and taking blood pressure readings. The road there was a bit bumpy (literally) thanks to road construction. Despite getting started a bit late due to the costruction and a non-functioning projector, it was a great program. A large, stuffed batman doll and an inflatable CPR doll, MiniAnn, served as the willing patients during the demonstration. Back at the hospital we intended to interview the hospital administrator about both programs in which we are involved. Unfortunately, he was not there. But as Dr. D says, “Flexibility is our motto.”

After lunch together, we all piled into a couple carritos (small taxis) and headed to La Sirena, which is basically a slightly smaller version of our super Walmart in the States. They have air conditioning and ice cream with marshmellow fluff topping. Needless-to-say, it’s a small piece of paradise here in beautiful, hot, sticky San Francisco de Marcoris. There we worked on our presentations while munching on snacks in the food court.

Tonight a few people are going out dancing in town, while the rest of us are staying home to write blogs and get ready for our one-and-only trip to the beach tomorrow. Happy Weekend to all!!