First MRW Day at the Farm!

This semester I am happily back at Michael R. White for my Capstone. My Capstone originally started with hosting focus groups with children, parents, and faculty at Michael R. White (MRW) but it quickly grew into a larger project that involved more of the school community. MRW is a very special Cleveland Public School as it is designated as a STEM School and sports a greenhouse and community garden on its very own property. My group and I fell in love with this space as we imagined it as an outdoor classroom to enhance the students' learning.

As our group started brainstorming about how to effectively utilize this room and incorporate the data collected from the focus groups, we came up with an idea to help improve the science and health class curriculum. Since MRW lost their school nurse and have limited funding, much like the sad reality that most Cleveland Public Schools face, we had to be creative and devise a way to achieve our goal. Pulling from our resources at Case, my group members and I formed a partnership between Case's University Farm and MRW. Five field trips were arranged and each trip had an agenda for the day: a mixture of science and nutrition to educate the children about their own health while exploring the field of science.

This arrangement made me very happy because not only were we addressing the needs of the principal but we were working within the aim of Dr. Lotas' grant. Obesity and hypertension are prevalent in MRW and by making nutrition lessons fun hopefully the kids will absorb the material. I was the first to present on Friday, October 21st and I had to tackle ecosystems and nutrition. I had no idea how they were related but then I began to think outside of the box and it clicked.

Since MRW has a plot of land that they can use for gardening, I took the approach that gardens were an ecosystem within themselves and we humans are involved in that mini ecosystem. After all humans play a pivotal role in various ecosystems. I created an interactive power point that was full of colorful pictures and age appropriate material. After our mile hike through a forest ecosystem, we discussed the vitamins and minerals found in certain vegetables. The kids were so impressed by seeing a carrot being pulled out of the ground!

Although the day was exhausting and it rained the entire time, the students from MRW appeared to have a blast. By the time we put them back on the bus, we all got hugs from enthusiastic faces. I think they are eager to return to their next farm field trip.

Otis Moss Jr. Health Center

My time at Otis Moss Jr. Health Center has been great so far. I love the atmosphere at the health center. Otis Moss Jr. Health Center is unique because it incorporates both spiritual and physical health. I have been spending most of my time working with a nurse in the pediatric office. My daily duties include checking patients in for their physicals and appointments, drawing up and giving immunizations, drawing blood, performing in office lab tests and sending letters to patients and their parents regarding lab results. I also help with triage calls, nebulizer treatments and throat swabs for Strep tests. One of the things I have noticed at Otis Moss is the difference between the role of the nurse in the office compared to a nurse in the hospital. At Otis Moss, the nurse's main roles are to answer and assess triage calls, give immunizations, and perform patient teaching.

One of the projects that Jazmin, Nailah and I worked on this semester was a diabetes class. We were responsible for contacting patients, organizing educational handouts and communicating with the instructors of the course. It was great to attend the class and see how our hard work paid off. The patients were all very engaged in the class, and I think they learned a lot from our packets and the insight of the instructor.

For our main research project we decided to tackle Vitamin D deficiency and insufficiency. We found out through our research that over 50% of pediatric patients at Otis Moss are either Vitamin D deficient or insufficient. Our project focuses mostly on the education of parents to help their children gain more Vitamin D from the sun and food. As the semester winds down, I look forward to seeing if our Vitamin D education has worked and if any Vitamin D levels increase.

Cleveland Schools

This semester I have been visiting elementary schools in Cleveland and screening kindergarteners and third graders for height and weight as part of the Prentiss grant. The children are so cute and a lot of fun to work with. Most of the schools have been so welcoming and are very appreciative of our help. Last spring many of the CMSD school nurses were laid off and now there are not enough nurses for each school. There is such a need for them and the students would benefit greatly if each school had their own nurse. The secretaries now have to administer medications and hand out band aids which takes time away from their job. Kids are being sent straight home when they feel sick instead of being seen by the nurse. The schools have really welcomed us and even begged us to stay!

I have enjoyed seeing the schools and how each one is different in its own way. Some schools are brand new and others are older but have a lot of spirit and character. I have been able to see many different areas of Cleveland and drive through the neighborhoods where the students live. It has given me some insight into their home life and obstacles they may face that can affect their health. I cannot believe how fast this semester has gone! We have three more weeks to finish up the screenings. This week we are screening with Ursuline College nursing students. I'll keep you posted! See you next time..

CMSD Schools

Being in the Cleveland Metropolitan School District has been more exciting than i expected.  Throughout this screening process I have had the opportunity to visit various schools throughout the Cleveland Area.  I have had both rewarding and challenging experiences so far.  I have learned quickly just how big of a challenge the Cleveland schools face everyday with the current layoff of their school nurses.  At one of our schools on a Friday screening day, i encountered a little kindergarten girl who was very shy and did not speak to anyone including her teachers and fellow classmates.  The teacher had asked our instructor to look at the student because she suspected the student may have a case of head lice.  She informed us that the student had a history of head lice in the past and that the child's living situation was not the best.  Our instructor took a look at the student and could tell right away that eggs were present on the child's neck and hair.  The hardest part of this situation was that the head lice was recurrent for the student.  Clearly the parents do not understand how to properly treat this and further teaching is required for the parents.  This specific school did not have their own school nurse, like the majority of the schools n the CMSD.  The nurses are only present in the schools to look over immunization records, which are needed on record for the state.  This experience demonstrated first hand how difficult and challenging public health nursing can be.  Not having enough school nurses for each CMSD schools poses serious health issues for students and places a great burden on faculty and administration in the various schools.

Saying Goodbye to Bethel

I cannot believe today is my last day in Bethel - I will miss this place a lot. Southwest Alaska has been my home for the past ten weeks. Although I have been alone in this capstone experience, I have by no means been lonely living here. I have made wonderful friendships that will endure past my departure, as well as learning SO much about Alaska Native culture. Who else could say that she tried walrus soup and caribou stew during her capstone? To tell you the truth, walrus is a bit chewy for my taste, but... caribou is absolutely delicious!
During the past few months, I have truly come to respect and admire the residents of Bethel. It takes such courage and determination to survive out here in the "bush". Getting food and maintaining your home are like a second full-time job! Nonetheless, the trade-off to everyone's hard work lies in quiet tranquility and beauty of the flat tundra. Nature has so many wonderful things to offer when you actually take the time to stop and pay attention. Back in the Lower 48, the hustle-and-bustle of this dog-eat-dog world causes people to run around in circles... gaining money but losing their sanity. In Bethel, there is no obsession with materialism simply because it is completely unpractical. No one cares if you drive the hottest new Lamborghini -- in fact, if you do, you're probably going to get stuck in a mud puddle and everyone will stop to laugh at your silliness. Instead, it is the people that really matter. The sense of community in Bethel is an amazing thing to witness. Nowhere else in my life have I come across such a large group of people who all wish to make their community better.
Nearly every person that I have talked to while I've been here has said the same thing... 'when I first arrived in Bethel, I hated it; it's so flat and boring and there's nothing to do here.' Yet here they are, years later, still in Bethel, telling me their stories. When I ask what kept them here, they all answer: the people :)
In conclusion, I am so happy I chose to come to Bethel for my senior nursing capstone. In addition to learning tons about Public Health, I learned about the Alaskan way of life.. and most importantly, I learned about myself.

CMSD Schools

My experience in the Cleveland Metropolitan School District as a participant in the Prentiss Grant has given me a look into poverty in an urban area. The study is done over five years and the end goal is to track obesity rates and follow the kids throughout their years at the schools; kindergartners till fourth grade, and third graders till seventh grade. We are responsible for collecting the data for kindergartners and third graders in all CMSD elementary schools. There is a lot of behind the scenes work for prepping the schools that I wasn't aware of last year when working for the grant in community clinical. The day before we go to screen the schools we have to do a pre-visit of every school to meet the staff, see where we are going to set up our equipment and find out where the classrooms are to make it a smooth screening day. Also, all of the data on the iPads need to be loaded on and off the computer into specific files which we prep the day before. The students are fun to work with and always have questions about what we're doing. The kindergartners love to hold your hand and really look up to you. Our goal is to complete all schools by the end of this semester, so until next time we hope that will be able to achieve that!

Final Project

Clay and I only have about a week left at the Catholic Charities and I have no idea where the time went! This has been such an extraordinary experience and I am grateful for all those who made it possible. For our project, we decided that diabetes education would be beneficial to this population because there are very few patients who do not have either personal or family history of diabetes. The common teaching points for diabetes tend to focus on healthy eating, exercise, and medications. Therefore, in the hopes of avoiding redundancy, Clay and I collaborated with Sister Carole and our clinical coordinator to develop a poster which highlights the potential affects of diabetes on the body systems, something not as commonly discussed. We printed 18x24 inch posters and put them in each of the four exam rooms. Immediately, patients used the poster as a discussion starter; “My sister has diabetes and she hasn’t had her eyes check in 10 years! Should I tell her to go?”, “Wow, I didn’t know diabetes could affect the heart like that!”, etc. To statistically analyze the effectiveness, we give patients a pre-test while they are in the waiting room, then a post-test with the same questions after their visit is completed. Though we have not done any calculations to show numeric improvement, it is obvious when we compare the pre and post-tests that patients are gaining valuable information from the posters! This is such a great feeling to know what we are doing will have lasting effect on patient education. :)

CCBH Family Planning Clinic

My experience thus far at Cuyahoga County Board of Health (CCBH) has been a very enjoyable and educational one. My group and I are working very hard at advertising the “My Life, My Body” Family Planning Clinic in the Parma area. This Clinic is a Title X Clinic, meaning it is governmentally funded so that no individual may be turned away from services or care. The Clinic provides low-cost to free birth control options ranging from the pill to the intrauterine device (IUD) to condoms and barrier methods, HIV/STD testing, pregnancy testing, counseling services, and countless educational resources. Our site coordination, Sandi Hoch, is very passionate about the topic and is constantly looking for ways to better incorporate us into the world of public health. My group and I have gone on Newborn Baby, Help Me Grow, and environmental health visits with different professionals working at CCBH. We have shadowed Sandi for a day or two in the Family Planning Clinic, talking with her about how to better reach teenagers at risk for unintended pregnancy and HIV/STDs. We will also be shadowing a nurse in the immunization clinic at CCBH in the near future. Our advertising for the Family Planning Clinic has been ongoing. We have a booth at Tri-C West twice a week, have visited CWRU two times, have hung up flyers at more than 100 business in the Parma area, put CCBH and the Family Planning Clinic on Googlemaps, and uploaded information on radio stations community boards and events. We look forward to doing more outreach for CCBH…we hope to reach 300 businesses!

Cleveland Department of Health

I am well into my experience at the CDPH now. The clinic i am at is a reproductive health clinic. the services offered include STD testing, HIV testing, Pap tests, birth control, and immunizations. I am going to share my first experience at the immunization clinic.

Every monday morning parents can bring their children in for immunizations. This week we had 7 patients, ranging from 14 months to 15 years old. I administered the required vaccinations to all of these patients, with the exception of the 14 month old who the RN took over for. For the most part it was nothing that i hadn't expereinced before. Once you've given a few IM/SQ injections it is pretty routine. Even the younger children handled it well and didnt put up a huge fuss. However, the last patient of the morning was a different story. He was 5 years old and was slightly developmentally delayed. He required 5 vaccinations. He was ok for the first one, but once he realized what was going on, he lost it and started screaming at the top of his lungs and attemped to escape. He was sitting in his mothers lap, but he was a larger 5 year old and his mother struggled to restrain him. The RN jumped in to help, but both of them combined still struggled to keep him still enough to administer the vaccinations. I managed to administer the other 4 with some difficulty, but successfully. I felt terrible for the boy and once the shots were done he wouldnt let me touch him to put band-aids on. He didnt understand the difference. When it was all said and done the boy calmed down and gladly accepted the stickers we had to offer.

This experience sticks out in my mind because it was the first time i had to give injections to children, and because it is so different than a usual day at the CDPH. I don't think i will ever forget that little boy!

Southeast Alaska - Good knowing ya

My experiences in Southeast Alaska have been more than I could have imagined. Reflecting on my journey, there were so many people I met and amazing places I visited that I will never forget. This was truly a once in a lifetime experience and I highly recommend it for future years. One of my favorite experiences was being able to visit two native villages: Hoonah (Population: 700) and Angoon (Population: 500). In these villages, the Public Health Nurse and I offered health awareness classes to all ages and met the medical staff who are so important to these cultures. We even got the chance to get the community on their feet and leave a smile on their faces for a few days with multiple Salsa and Zumba lessons/socials. It was an amazing resource to work with the brave staff that understood the community as it is well-known that building trust in native populations can be a great challenge in your success as health care providers. Everyone I met was very welcoming and I felt that I had accomplished my goal in many of the communities visited.

Aside from visiting rural villages, as my grand project, I was able to implement and jumpstart an exercise program with a local youth center in a low-income housing area. This program is meant to focus on leadership and teamwork skills as these are two qualities that can be very valuable in the children's future. I was extremely glad to see the participation increase rapidly during each visit both by the young students and adult leaders. This is a program meant to last for years to come, therefore I am excited to keep updated on the progress and future achievements.

I feel honored to be able to have an experience like this in one of the most beautiful parts of the country. Alaska has treated me well and has left me with amazing stories I will be able to share to future generations to come.

Focus Groups

Today we held our first of six focus group meetings, this one with the parents of students at Michael R. White elementary school in Cleveland. Or should I say, we attempted to hold our first focus group. After much preparation on behalf of the senior capstone group, two juniors, and Dr. Killion, not one parent showed up. It’s not as if we told them about it one time and expected them to show up, we pretty much hounded the parents who initially signed up at the MRW Open House. We called them a week beforehand to get an initial count of who would attend, and then called the day before the meeting to remind the parents. We had six parents who said they would attend, and we had hopes that a few more would show up.
The meeting was set to start at 4pm, so the four senior capstone students arrived at the school around 3:15 to set up. We brought with us light refreshments that we had bought earlier that day. We were very optimistic and ready to get the parents’ input on how we could best help their children be healthier during the school day. We were also looking forward to the next day’s focus group with the faculty and staff of the school. However, we first knew something was amiss when the overhead announcements came on to signal the end of the school day. The announcements told the wrong dates for the focus groups and mixed up the parent and faculty dates to do some sort of miscommunication. Not to be disheartened, we told the faculty the correct dates and continued to wait for the parents. At about ten after four, we began to realized that no one was coming to our meeting. Finally, at 4:30, we packed up our belongings, put the chairs and refreshments back, and sat down with our faculty advisor, Dr. Killion. The four of us were pretty unhappy about the turn of events, but Dr. Killion was very encouraging. She told us that it is common for such a thing to occur, and that we will certainly be successful with our future focus groups. She also told us a story of a focus group she held to which no one came, and then the next day she had another one with a great turnout. She made our next focus groups look much more hopeful than I had thought, and I now look forward to our faculty and staff meeting tomorrow. I am ready to start making some great changes for the students of Michael R. White.

Tri-C Outreach!

Today my group, (Hannah, Jill, Mary Clare and I) went to Tri-C West to market the Cuyahoga County Board of Health’s (CCBH) Family Planning Clinic. The Family Planning Clinic is a title X clinic located at CCBH. The clinic is open two days a week offering a variety of services such as STI testing, HIV testing, pregnancy testing, birth control counseling, and more. Since it is a title X clinic the cost of each visit is based off a sliding scale of household income. This is a great resource for many people without insurance or with limited finances. We set up a booth in the main building of the college with a giant tri fold and various pamphlets. We also created little information baggies filled with candy, condoms, and pocket sized handouts. The little bags were our way of luring the students over to our table to have something to take with them.

We were there from 10am to 2pm and we had around 12 students come up to our booth and talk to us. Some of the females were interested in the birth control options and the possibility of getting birth control for free. Most of the males took the candy and then later we over heard them laughing about our pamphlet of “how to put on a condom.” Even though they were laughing about this, at least our information was getting read and not just thrown into the trash.

From now on every Tuesday 10am-2pm, and Wednesday 4-7pm we will be rotating which two students go to Tri-C and sit at our booth. We will continue this for the rest of our Capstone experience. Our supervisor at CCBH, Sandi, said that every time CWRU students sit at Tri-C they gain a few Tri-C clinic patients. We wore our navy blue FPB polo’s today, but we also planning on dressing in business casual clothes on another day to test to see if we seem more approachable without Case’s name attached to us. It will be interesting to see if changing our attire will make any difference.

Our goal this semester is to increase awareness about the services that the Family Planning Clinic has to offer and increase the amount of patients seen in the clinic. We have been performing outreach throughout the community all semester long, and hopefully outreaching at Tri-C will bring in a large amount of new clients.

10/8/2011

We were invited to attend a fundraiser for the Trailriders, a committee of elders who teach children the importance of horses, how to ride and how to take care of them. We went horseback riding, ate a traditional meal, and listened to a live band. It was a great experience to learn more about the community!

Bethel, Alaska

As the saying goes - "time flies when you're having fun"... little did I realize how correct this age-old statement is until I came here to Bethel. I cannot believe that I have been in Alaska for almost two months now. When I first stepped off the plane onto the tarmac seven weeks ago, I thought I knew what to expect in Alaska. However, I have been very pleasantly surprised... especially since some of the "myths" I had been told before arriving have not quite held true.

While Bethel may not be pretty picturesque peaks like those you would see in Fairbanks, the area is by no means ugly. Bethel is "just flat tundra," nevertheless, the beauty is in the landscape's simplicity. Since the land is completely flat in every direction, the sky appears as if it goes on forever and the clouds look as if a white blanket lying directly over you. The Alaskan terrain is extremely diverse, and you need only go upriver a few hours to find mountains and trees lining the horizon. Beauty is truly in the eye of the beholder.
Secondly, Alaska is not boring.While there may not be movie theaters or bars or shopping malls on every street corner, there are winding rivers and salmon and berries... moose and caribou and seal... nature is alive and kicking out here. The wondrous part of my adventure up here in "the bush" is that superficial glamour and materialistic nature of American dream disappear faster than the morning fog. As my host mother says - 'Bethel will smack the peacock out of any woman!'

I am so grateful for the opportunity to complete my Capstone here... nowhere else could I have seen first-hand a patient with ACTIVE TUBERCULOSIS... witnessed authentic Native Yu'pik culture... tasted walrus soup... or met a famous Russian explorer during a village trip (I dare you to google Misha Malakhov... so cool!!). I cannot wait to see what the rest of my time in Bethel has in store for me :) Til next time....

9/18/2011

This weekend we traveled to the Grand Canyon on Saturday and Red Rock State Park in Sedona on Sunday. Both places were beautiful but I really enjoyed hiking at Red Rock. We did about 4 miles and even climbed a mountain!

-Jennifer Doak

Capstone at Gila River Indian Reservation, Arizona