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Addiction in Appalachia

Appalachian communities are among the hardest hit by the national opioid addiction epidemic. According to the Centers for Disease Control, West Virginia has the highest rate of drug overdoses in the country. Opioids are killing 40 people per 100,000 that use them in West Virginia–a truly staggering number. Here on the ground in the Cabin Creek Clinics, nearly every patient we have seen has been directly touched by opioid addiction in some way. We hear about it every day.

So why has West Virginia been hit so hard by this crisis? And what are health leaders here doing about it?

Today’s opioid epidemic is, in part, an unintended consequence of providers trying to better serve their patients. In the late 1990s and early 2000s, there was a push to improve treatment of patients with pain. Pain became known as the “fifth vital sign”, and a whole generation of providers was schooled in this new understanding of pain. This, of course, had good intentions. As providers, we want to be able to do something to alleviate pain for our patients. At the same time as this push for better pain management began, however, several new opioid drugs hit the market. Purdue Pharmaceuticals released OxyContin in 1996, billing it as a safer and less addictive opioid. This perfect storm of more varied and widely-available opioids entering the market (marketed aggressively as less-addictive and safer), and a call to more thoroughly treat pain or be seen as doing a disservice to your patient, is likely one of the primary reasons for the opioid epidemic. Today, more than a third of Americans are prescribed painkillers every year. Once a patient is hooked on these addictive meds (and they are highly addictive, despite misleading advertising from the drug companies), they often have to turn to buying opioids on the street to sustain their habit. It’s expensive to buy pills, so many switch to heroin. In most places, heroin goes for next to nothing–less than the cost of a six pack of beer. The rest, as the say, is history.

Much of the primary industry here in West Virginia is highly physical, dangerous work. Coal mines, oil rigs, and agriculture jobs often lead to injuries and physical aches and pains. These jobs can also be isolating and stressful. Many in these industries are considered working poor, living paycheck to paycheck under constant mental and emotional strain. Opioids don’t just help physical pain. They tend to numb the emotional and mental pain, too. In a place like Appalachia, for a myriad of reasons, there is plenty of all these kinds of pain to go around.

Most experts agree that addiction is a mental illness. Once someone is addicted, they will always have that addiction. So what can be done to help these folks break the habit?

Here in Cabin Creek, providers combine Medication Assisted Treatment or MAT, with an extensive behavioral health program. The MAT clinic, located in Kanawha City, provides methadone, suboxone, subutex and vivitrol to patients who are addicted to opioids. These medications help reduce cravings for opioids, which allows patients to remain in treatment and reap its benefits. Patients are required to attend weekly individual and group therapy to remain in the program. Therapy is key–the medication can treat the symptoms of addiction, but therapy helps people deal with the emotional and mental pain that keeps them using.

Many providers in primary care, including those at Cabin Creek, have pledged a more mindful approach to pain management, prescribing only short courses of opioids when absolutely necessary for trauma, and turning to other methodologies such as PT, massage, or NSAIDS for other types of pain. Further, Cabin Creek clinics are slowly weaning patients who have inappropriately been prescribed opioid pain medication, off of them and employing more proven modalities. This is a long and arduous process, but Cabin Creek clinicians believe it is critical to prevent potential addiction and abuse. Treating patients in a fast-paced clinic often means you only have time to prescribe a pill and send folks on their way. The opioid crisis is forcing prescribers to step back and reassess the long term damage they may be doing to their patients with this approach.

At Marshall Medical School here in West Virginia, medical students are receiving 30 hours of content on pain management in their first two years of medical school. Faculty believes that the earlier the exposure the better, and that the more providers understand the impact of opioids and see that impact in their training, the better able they will be to serve patients in this area.

I, for one, know that the West Virginia Cabin Creek rotation has given our group a first hand look in to this crisis. Several of us have actually gotten to work in the MAT clinic and see what these patients are going through. Pain is an issue for patients in every setting. We need to remain current on the evidence for how best to treat each condition, and remember the far reaching affects our choices will have.

West Virginian Word of the Day:

Pepperoni Roll (n.): A distinctly West Virginian food made of a soft white roll with pepperoni baked in the middle. It is the unofficial state food, found across the state, especially in convenience stores.

Inspiring Nursing Leadership

The Nell Hodgson Woodruff School of Nursing at Emory University honors the hard work and dedication of nurses around the world – the unsung heroes who make such significant contributions with so little fanfare. Whether they are promoting health and preventing disease; providing care at bedside; conducting research; or teaching the next generation of health care providers, nurses use their knowledge and skill to care for people and improve communities every day.

But nurses also received help and support from many along the way. Below, Emory nurses reflect on the amazing individuals and life events that have shaped their careers as nurses.


environmental portrait of School of Nursing Dean Linda McCauley

Linda McCauley, PhD, RN, FAAN, FAAOHN Dean and Professor

The most influential person(s) in the development of my career was first my mother, who was a nurse and who encouraged my love of health care and supported my interest in providing individuals with the tools that they needed to stay healthy or to cope with medical concerns.  The second influence came in my early 30s through my doctoral program when I met epidemiologist Barbara Valanis, now senior investigator emeritus for the Kaiser Permanente Center for Health Research. Barbara inspired me to balance nursing and environmental science, taught me how to write successful grant applications and the importance of dissemination of knowledge.  Barbara authored several editions of Epidemiology and Health in Nursing and Health.  I am fortunate to have had many mentors in my professional career, but these two women were most influential in shaping my professional career.

Sharon Pappas, PhD, RN, NEA-BC, FAAN, Chief Nurse Executive (CNE)

When I talk about my career as a professional nurse, I often reference the incredible education I have had beginning with the Medical College of Georgia where I received my BSN in 1975 after my Mother’s physician advised her to make sure I attended a school that gave me a bachelor’s degree because he thought that is what ‘nurses needed today.’ Three decades later after exhilarating clinical practice in emergency and cardiology and progressive leadership roles, I received my PhD from the University of Colorado, and that was my true trip to the well loving every minute of those 5 years! All of this background is foundational to my true inspiration. I was fortunate to be in the right place at the right time to encounter some very important individuals who inspired me to keep reaching and to actualize the impact nurses should have on patients and communities. First were my parents who taught me how to work hard and keep a sense of humor. Next a CEO showed me the importance of what patients think about the care we provide and a second CEO who pushed me to understand the financial impact of effective nursing care. There were also nurses who inspired me – one CNO who led her organization to be a Magnet hospital – eventually, I did that as well. Also there was another nurse executive who demonstrated the importance of nurse-led research – I followed that lead. Finally, the inspiration I get from nurses keeps me fueled to put love and energy into making sure nursing work environments are healthy because in the right environment, nurses will always do great work and most receive professional joy from their practice. Florence Nightingale is my historical idol, and she challenged leaders not to measure our leadership by what we individually do but how we assure the right things are always done. This is the leadership I live to provide.

Susan Shapiro PhD, RN, FAAN, Clinical Professor

My mother, too, was a great influence on my choice to become a nurse, and although she didn’t work outside the home during my childhood, knew she had been a nurse, as did all the neighbors. Adults and children alike came to our house with their questions and minor emergencies, and she knew both what to do, and how to make her “patients” feel at ease. I wanted to be able to do that…which takes me to the second biggest influence on my career choice – my undergrad alma mater. Like Emory, University of Pennsylvania prepared the next generation of nursing leaders, and the critical lessons I learned there have been a major source of my successes over the years.

Deena Gilland, MSN, RN, NEA-BC, VP of Patient Services and Chief Nursing Officer, Emory Ambulatory Care

My Mom was one of the greatest influences and inspirations in my life overall as well as my nursing career.  Although she was an educator, not a nurse; her compassion, caring and love of people had a huge impact on me.  She taught me to always put others before yourself, evoke trust by your integrity, and to find joy in every situation.  She not only taught these, she role modeled them consistently in her own interactions with people.  These attributes and values have been my guides throughout my nursing career and have helped keep me focused on what matters most.

Mi-Kyung Song PhD, RN, FAAN, Professor, Director, Center for Nursing Excellence in Palliative Care

I still dream about my years in middle school where most of the teachers just graduated from their teaching program. It was a brand-new school with a bunch of brand-new teachers. Teachers were young, energetic, and most of all, understanding teenagers. I often skipped my daily music lesson to spend more time with my teachers after school. We mostly talked about poetry or played music together. One day, a new teacher arrived. She had a nursing background. She quickly joined our after-school activities. I don’t know exactly why but her stories about her interactions with patients and family members made a great impression on me, and it seemed to me only logical to apply for a nursing school, College of Nursing, Catholic University in Seoul. It is one of the best nursing schools in Korea, known for Hospice care

Rasheeta Chandler, PhD, MSN, APRN, FNP-BC, Assistant Professor

I grew up with humble beginnings in a small, rural town in Florida. I was one of the first in my family to go to college and then go on to earn a doctoral degree My ‘Big Momma’ (my grandmother) who had a fifth grade education, was married at 14, and had to work in the fields harvesting crops to support her 17 children. While I was in school, my grandmother always said to me, “you’re my doctor.” Her words of encouragement are what motivated me to complete my doctoral education and become a clinician. She also fueled my desire to be a mentor and champion for talented students who weren’t fortunate enough to have a Big Momma.

Clint Shedd DNP, RN, FNP-BC, Assistant Clinical Professor

I became a nurse at age 30 as a second career, and I’ve worked with and been mentored by many inspirational people in the nursing and health care professions. Throughout my career, fellow faculty Dian Evans has been particularly influential:  she was my faculty when I was an undergraduate BSN student, she was my preceptor when I was in an FNP program, and she inspired me to get my DNP.  She also helped me get an appointment at Emory’s School of Nursing, where I’ve met many other nurses and nursing students who, like Dian, are inspirational to work with.

 

 

 

Quyen Phan, DNP, FNP-BC, RN, Clinical Instructor

I had the chance to work with the native Canadians in remote villages as an outpost relief nurse in northern Ontario. I felt inadequately prepared to make an impact in the health of the people I had to repeatedly medivacked out of the villages because of preventable chronic diseases. This same frustration happened after I worked on a renal pulmonary unit at an acute hospital in Atlanta. I found the tools to solving the problem in the form of a Master’s Degree in Public Health Nursing, and later, a Doctorate in Nursing Practice. After working in public health, I also discovered the love of teaching. Having built a career in public health nursing and nursing education, I can say that I have made an impact teaching future nurses to not only care for individuals in sickness, but also promote health and prevent illness for the population.

A Warrior’s Weekend

Richelle St. Louis, BSN Junior, BUNDLE Scholar

For my pediatric rotation, I had the privilege of volunteering at a Camp Twin Lakes-sponsored event for military veterans and their families through the Wounded Warrior’s Program. The point of this camp was to provide a weekend of time devoted to building relationships within families whom have had to deal with prolonged separation due to serving in the armed forces. For three days, a group of Emory students stayed at the Camp Twin Lakes site in Windsor, GA and were responsible for encouraging and facilitating activities that the families would participate in, ranging from scavenger hunts to Top Chef cooking battles.

I had been assigned to a family with a young girl who was the daughter of an injured veteran. In just the first few moments of meeting my assigned family, I felt so welcomed and accepted. They spared no time to make me feel as if I was a part of them and were eager to share their stories. For one of the first camp activities, we were asked to create a Native American tribal name that we would go by for the rest of the weekend. It was extremely interesting to see how creative the families were in coming up with some pretty interesting names. What I really enjoyed about the camp was finding myself being pushed beyond my comfort zone. I am the type of person who tends to stay quiet and withdraw into a crowd. But during my time at the camp I was actively involved in the activities and found myself doing things like karaoke in front of a large crowd of people.

The most somber part of the weekend, was when the parents and children were split into groups and asked what they wanted to tell each other about struggles that they were having from the pressure of military service. Some of the things that were noted were, “I want to spend more time with you,” “I feel alone in my own family,” “and you don’t understand what I am going through.” Being the daughter of a military veteran myself, the emotions that these families were experiencing really struck me. It reminded me how I felt growing up in a family where my father was never around due to deployment. These emotions became even more tangible as I watched fathers and children with tears in their eyes as they spoke about these hardships. It made me realize the true significance of the camp was in providing the time and space for families to truly open up to each other about how they were feeling and find ways to mend broken relationships and build stronger family bonds as a result.

In the beginning, I did not see how going to camp for weekend would make me a better nurse. From my time at Camp Twin Lakes, I learned that there are factors beyond what the health care provider sees in the hospital that affect the health and lifestyle of people, that are completely out of the patients control. The stress of potentially losing a loved one in combat or having to deal with the separation or constant changes in life, can have a negative effect in whatever population you are looking to serve. I believe it is important for nursing students to recognize that and find opportunities to volunteer for different programs that serve varying populations, in order to be more prepared and open minded when engaging patients in the clinical setting.

My First Clinical Experience

Aliyah Saadein, BSN Junior, BUNDLE Scholar

I remember all the emotions I felt prior to entering nursing school; anxiousness, fear, excitement, and everything in between. Aside from the school work, most of those feelings stemmed from what would be a real life experience as a nurse during our clinical rotations. When the time came in the middle of the semester, I was assigned to a cardiac step-down unit with a group of people I did not know.

On my first day after orientation I remember feeling so excited and prepared for what was to come; little did I know how wrong I would be. I did not know exactly what I expected but I definitely thought at least some things would be easy. I expected talking to patients, interacting with other medical staff members, and performing actions that I practiced prior in lab to be easy. In fact, the things I expected to be the easiest actually became the most challenging when I met real life people with very real problems.

I had to practice speaking to patients without spewing out the medical terminology they teach us in class while still educating them about their medications and their diagnosis. By the time I started clinical, it was around the middle of the semester. I adapted to nursing school quickly and by that time, I thought I had my time management skills under control. Once again, I was wrong. When I was in the hospital things constantly moved fast; patients were discharged, orders were changed, and my work evolved fluidly throughout the day. It became difficult to time everything correctly so that I could perform vital signs, assessment, medications, all while making sure the patient had everything they needed to be comfortable. I had to make sure that before I started the day, I made a game-plan of how I was going to approach the shift to make sure I completed everything in addition to charting (remember: if you didn’t chart it, it didn’t happen).

It also is easy to compare yourself to other peers during the clinical experience. Even though I tried not to, I found myself comparing my knowledge and skill ability to other students. I found myself thinking “I don’t know as much they do” or hearing about other students performing these intense skills while I had still only performed the basics, which caused me to feel like I was behind. Even though I still experience these feelings, I remind myself that these skills come with time and experience. Not everyone is in the same hospital or on the same floor so people are bound to perform different tasks. To make it a little easier for me, I had a great clinical instructor who always reminded us of that and always pushed us to reach out of our comfort zone and perform new tasks even if we were nervous.

I am only a second semester nursing student. By now, I feel like I have experienced it all but I know I have only seen a small fraction of what the realities of nursing are. Going forward with my clinical experience I remind myself that I am a student and that the whole purpose of my clinical experience is to learn and become better. Even though it is embarrassing in the moment, I also tell myself that is okay to make mistakes and it is better to make mistakes during clinical with an instructor around than as a practicing Registered Nurse. I still struggle with all of the things I have mentioned, but I know that I have learned so much and feel so much better as I step into the hospital now compared to that first day on the cardiac step-down unit.

My Experiences as a Student Nurse

Roya Shareefy, BSN Class of 2017, BUNDLE Scholar

Being in nursing school was definitely my most challenging years both academically and in life. When they say that nursing school takes over your life, I can say that nursing school truly did. I had to focus more on my studies than other aspects of life, and learn so much in a short amount of time. The clinical experience of nursing school allowed me to have the opportunity to put what I learned in my classes and readings into action. Clinicals really put in perspectivewhat it truly is like to be a nurse. We talk about this all the time in our classes, but nothing fully captures the skills and responsibilities necessary for nursing better than hands-on experience in a clinical environment.

I experienced so much during my clinical rotations. My first clinical rotation at the main Emory University Hospital eased me into performing nursing functions. I remember when I first started, I felt nervous about actually providing nursing care. When I compare myself to how I was when I first started clinicals, I have definitely learned and grown so much as a student nurse. One of my favorite experiences during clinical was when I had a patient who was first starting chemotherapy. My nurse preceptor told me that patients often experience an anaphylactic reaction to the medication when theyfirst start chemotherapy, so it is important to run the medication at a slower rate. My nurse preceptor said that if we had a patient who reacted to the medication, we should stop running the chemo, check the patient’s blood pressure, and then give the appropriate medication from the emergency kit. When I checked my patient a couple of minutes after starting his chemotherapy, I asked him questions related to a anaphylactic reaction. I also noticed his face was getting a little red and he looked short of breath. He mentioned having lower back pain, so I immediately stopped the infusion, started taking his blood pressure, and notified my nursing preceptor. His blood pressure was within his normal limits, so we gave him Benadryl via his IV. The Benadryl helped the patient, and we had the Benadryl running when we started his chemotherapy medication again, but at a slower rate stated by the physician. This time the patient did not have a anaphylactic reaction, and tolerated his chemotherapy well.

This experience taught me how important it is to asses your patient and to teach your patient beforehand about the reaction the patient could have due to the medication. My nurse preceptor and I taught our patient about the reactions he could have due to the chemotherapy; due to our teaching, our patient recognized his symptoms and was able to know that what he was experiencing was an expected adverse reaction. During clinicals, I had many experiences where I had to think on my feet and conduct nursing care quickly. These experiences taught me a lot about how to be a nurse and emphasized the importance of conducting proper patient care.

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Roya Shareefy is  a fourth year student from Atlanta, Georgia pursing her BSN degree at Nell Hodgson Woodruff School of Nursing at Emory University. She is a BUNDLE Scholar, and serves on the executive board of Emory’s Multicultural Student Nursing Association.

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.

SGA President: Making Leadership Fun

Stefka Mentor, BSN Junior, BUNDLE Scholar, Junior Class President

Hi everyone! My name is Stefka Mentor and I am a junior in the traditional BSN cohort. I am originally from New York but I completed my first two years of undergraduate here at Emory University. I am almost finished with my first year of nursing school, and it has been my hardest year yet. Nursing school is difficult and different than anything I have ever experienced before, but it is also completely worth it. In this past year, I have met incredible faculty, amazing students, and even greater nurses. I have been exposed to new ideas, new personalities and new ways of thinking. However, my greatest accomplishment and favorite part of nursing school is serving as SGA president for my cohort.

I was elected to serve as President in September and have been working hard with my board to make nursing school as fun and manageable for our fellow classmates as much as we possibly can. As president one of my key roles is serving as a liaison between the students and the faculty. I work hard to communicate the concerns and needs of my classmates to professors in hopes that they can be resolved and that a common ground can be reached. This is unlike any role I have or could have played while a student in the college. I get to directly interact with faculty, I get to know all my classmates and truly get to be a leader. Professors listen to the concerns of students and they are continuously working to better our experience. To have such an active role in this betterment is honestly a blessing.

Another one of my key roles as president, and my favorite role, is planning fun, destressing events for the cohort. In the fall, my board and I planned an ornament decorating event, where the students came out decorated ornaments of their choice, got to keep a free Emory Nursing phone wallet, and enjoyed delicious hot chocolate and hot cider. The students loved it. They were happy to take some time out of their busy, stressful day to enjoy a cup of hot cider and color. I was happy to see their faces. Just this past month, my board and I planned a buffet lunch for the cohort as nice way to welcome Spring. The students were surprised but so excited. Some students forgot to pack lunch that day, so they were so happy to learn they didn’t have to spend any money and they had a hot meal waiting for them.  I couldn’t stop smiling. There is nothing I enjoy more than seeing my classmates relaxed, socializing, and happy to be at the school of nursing. The events we plan, give them that.

Before coming to nursing school, leadership seemed like a chore or a duty. It seemed as if it wasn’t something someone choose to do, but rather something they had to do. I learned quickly, that I was wrong. Leadership is a choice and it’s the best choice I have made. I wanted to be SGA president, I wanted to make my peers happy and I wanted to make their experience here at the school of nursing fun and everything they want it to be. There is nothing about being a leader that feels like a hassle but instead it’s enjoyable. Nursing school is hard but getting to serve as president makes up for it.

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

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.

 ***

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.

Confessions of a Nursing Student

Aaron Montgomery, BSN Junior, BUNDLE Scholar

It was cold. It was 5 a.m. so the sky was still pitch black.  There was not a single car riding through the streets.  I had never seen that stretch of road so empty.  I sped up my walking pace to make sure I didn’t arrive late.  The first day was here and I was determined to make a good impression.  I had a feeling that I was forgetting something so I did ongoing checks to make sure I had my supplies: white shoes, watch, stethoscope, blood pressure cuff, and pen.  I started going through all the skills I had been taught in school.  There was no way I was going in unprepared.  As I approached the building, a feeling of nervousness took over.  I took a few seconds to calm down.  Then it was time to go in.  This was my first day of clinical and it was time to get started.

Looking back at that first day in October, it’s hard to believe that I was ever that nervous for clinic.  My first clinical experience has hands down been the best part of my first year of nursing school.  Early in the semester I had a hard time adjusting to the struggles that came with the program.  I had to get used to life in a new city, a new college, and professional school.  I wasn’t used to a full class schedule in addition to clinical experiences.  I didn’t know how to condense the seemingly infinite amount of information down to pass a 50-question exam.  And most of all, I thought I would never get an NCLEX style select-all-that-apply question correct. Ever.  But never once did I second guess my decision to go into nursing.  However, it was hard to envision all that hard work paying off. But that changed when clinical began.

During my first day, I was assigned to a patient in his mid-fifties who was recovering from a stroke.  I started the shift by giving him a bed bath.  Up until that point I had always taken for granted my own ability to bathe myself.  It was truly an honor to help someone perform such a simple but personal task.  After he was ready for the day, I accompanied him to radiology for a swallow evaluation.  I had only read about this procedure in textbooks so I was excited to get to see it in practice.  At the end of the shift, I went with my patient to therapy.  I got to see how the therapists transferred patients from their chairs, helped them walk, and assisted them with their daily activities.  This became valuable during later clinicals when I had to help move larger patients.  I stayed busy the full day.

Then it was time to meet with our clinical group to discuss our day.  My instructor was very direct and open about the expectations she had for us.  She didn’t hesitate to tell me the areas in which I needed improvement.  I worked on those areas, which improved both my confidence and competence.  It was time to leave for the day.  I walked out and instantly started thinking about the following day and how much I dreaded the idea of returning to class.  It hit me that not once during my shift did I think about school, or any of my other struggles.  For those eight hours I put my needs aside and focused on my patient.  There was no doubt that this is what I wanted to spend my life doing.  So far nursing school has had its share of struggles and triumphs, but I wouldn’t trade the experience for anything.

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Aaron Montgomery is a junior in the traditional BSN program.  Originally from Torrington, Connecticut, he moved to Atlanta to attend Emory following four years in the military.  He is part of the BUNDLES program and is hoping to serve as a Student Ambassador for the 2017-2018 school year.