End of my Capstone Experience

The end of my global health experience has been great.  I have really enjoyed working with my peer as well as the Cleveland Health Department Staff over the past two months.  I feel that I have successfully partnered with the community and the agency that I was working with at the Thomas McCafferty Health Center.  I learned so much just from the interactions I had with the patients that came to the clinic on a daily  basis. 

Insights I have gained about the role of a public health nurse as a result of this experience include learning how different their roles are than a nurse working in the hospital.  These nurses are required to deliver information to patients over a short period of time with the hopes of the patient retaining the information.  As in the hospital, most times the patients are in-patients, and will hear the same patient information constantly during their stay.  I commend them for their efforts at educating a community on serious health issues which are preventable during their work day.  I have met my clinical goals which were set in week one.  I feel I have enhanced my scope of nursing skills by focusing on a specific type of nursing and still applying the same nursing concepts such as patient assessment, treatment and education.  I have become more comfortable with finding ways of relating to younger aged individuals in order to gain their trust and allow them to communicate with me as part of their treatment. 

There is nothing I would have done differently from my clinical experience.  Everything that happened from my experience has made me more knowledgeable and confident in my work.  I followed the rules, and succeeded in providing patient care with no mistakes, while learning at the same time.  These insights will help me in the future as a nurse by providing me with helpful information in which I could look back on whenever I am in the nursing field.  I learned more than just about a STD during my time at the health clinic, I learned how to become a better nurse.

My experience at the Cleveland Department of Public Health

First arriving to the Cleveland health department (McCafferty), I was surprised.  Initially I had a total different perception of the health center.  I envisioned it would not be as exciting as it has been so far.  Prior to arriving, I was not informed that it was a reproductive health/STD clinic.  After finding this out, I was excited for my venture over the next few weeks.  .  I knew I would be involved with a variety of age groups, diseases and issues, as well a diverse culture and SES statuses.  The role of the nurse here is mostly similar to the roles that I have observed or participated in previously during my clinical course.  The same rules apply as far as nursing qualities and common skills.  I am still involved with patients who are seeking health care.  I am able to assess, but not as thoroughly in the hospital, provide treatment, and patient education.  This is really important within this clinic because reproductive health as well as STD health is very imperative to a healthy life course.  Within the community I work, there are multiple sexually active adolescents, so providing effective education regarding prevention is very important to combat the STD rates.  I appreciate that I am involved hands-on with patient care, even though it is on an outpatient basis.   I hope to become more fluent and perfected with these skills and to make sure I am delivering the best and most important information while assessing if the patient has a good understanding.  The most important thing to me is making sure the given information is retained and used correctly once the patient leaves the office.  It is sometimes difficult when the patient is around my age or younger, and are reluctant to speaking with me about issues they are having.  Some come into the clinic and are embarrassed to speak to me (someone in there age range) about how they contracted an STD and there sexual behavior if they are being treated for something like “Gonorrhea”.  I am still learning the best ways to make them comfortable and open up to me about these things in order for me to give them the best advice and patient education in order to change their risky behaviors and prevent future re-occurrences of an STD.  I look forward to the rest of my experience here at the health clinic.

Synthesis of the Capstone Experience

Ultimately, we came to the National Youth Sports Program as nurse educators with one question: will our education and training in healthy relationship development change the way students react to negative situations?  Like any experience, we witnessed many ups and downs, which we had to overcome together as members of a group.  One of the most difficult challenges that we faced while at camp was the sociocultural barriers between the participants and us.  As nurse educators, we strove to meet our students at their education level, and broaden that knowledge base.  This was done so that NYSP participants could trust us, and come to us for any concern they were facing. One of our most difficult responsibilities was our education piece and working with the children in the classroom setting.     

Despite the challenges to improvement, our hope is that the participants have adopted relief strategies and techniques we taught to them for dealing with stress and anger management into their everyday lives.  We taught them to think of having a healthy relationship in terms of treating others the way you would like to be treated.  Such a simple phrase goes a long way, and really emphasizes the importance of maintaining this throughout their lives.  We would like the children to adopt healthy living strategies that evolve into healthy relationships with those they are around most often.  We taught them that while violence is prevalent in their community, by controlling their own actions, they can prevent themselves from heading down the wrong path toward destructive habits and decision making.  

Synthesis of Cleveland Public Health Department Capstone

     After completing the Capstone experience within the Cleveland Public Health Department's Reproductive health clinics (Thomas McCafferty and J Glenn Smith), I feel confident that I received an excellent public health experience. I was extremely apprehensive prior to beginning the Capstone experience, mostly because I didn't know what type of facility I would be at. It was a perfect placement for me and my interests in the public health area of nursing.
     I would like to share some of the most interesting and memorable experiences I had at the reproductive health clinic, as I feel that it best commemorates and explains my Capstone. I had a wide variety of patients. For example, I had a 14 year old African American girl who came in for STD testing with her 19 year old boyfriend. They were both positive for chlamydia and trichomoniasis. Both of those STD's are very common and easily treatable. However, the main issue is that the nurse practitioner was required to report them, as she was under-age and admitted to sexual intercourse with her "boyfriend" of 1 month. She also reported being raped at 13. She refused birth control because she stated that she was "trying to get pregnant." She was not open to counseling and ignored our education that we provided regarding safe sex practices. I also had a 17 year old Hispanic girl who also needed reported to Job and Family Services. She tested positive for pregnancy, syphilis, trichomoniasis, gonorrhea, herpes, and chlamydia. She stated that in the past month she had been with 5 different sexual partners. This indicates sex-trafficking, according to what the nurse practitioner told me. Both of these young girls complete disregard for their health, emotionally, spiritually, and physically really struck me. It was devastating to let them leave and go back out into society.
     On the other hand, I had several patients who were in for their "annual" STD check-up, and they tested clean. There are many people who practice safe sex and do receive annual or bi-annual testing for STDs. For example, there was a young gentleman who comes to the clinic every year (or when he has a new sexual partner) and he has tested clean continually. This impressed me, because many college students (including myself) are usually too scared to get STD tested- not many people even know much about it. Even after learning about STDs in nursing school, I definitely did not know half as much as I do now.
     I also had a 77 year old African American man who had some fun in Vegas for his birthday- a little too much fun! He was positive for gonorrhea. It proved to me that no matter what age, if you are sexually active (and not monogamous) you need to continually receive STD testing. Most STDs are curable, and all are treatable. Without treatment, most STDs can be extremely detrimental to your health. I found that this experience not only benefitted my personal knowledge and health regarding STDs, but I really felt that I was able to help the public by providing treatment and education regarding STDs, pregnancy, and other ailments.

End of Capstone and the Summer

I learned so much while at camp. Even though we were only there for three weeks, in the small time, we were introduced to a bunch of children who I an describe as one of a kind. They were the best teachers. Essentially, being a part of the dispensary staff, we were responsible for the medial care and the administration of insulin and helping the campers insert there insulin pumps. Most of the campers did everything themselves. At Camp Ho Mita Koda we encouraged independence and increased responsibility. Most insulin administration was done by the camper with our supervision. This was a great time for us to learn about their regimen at home. If a camper was putting on their pump, usually they would talk us through it. Because there were different types of pumps, it was nice learning the difference between them all. I didn't know how good the technology was today. I actually really liked the pumps.
During the last weeks of camp, some residence joined the dispensary staff. It was good talking to them also. They talked to us about the difference between type -1 and type -2 diabetes. They explained it to us in a way that anybody could understand. I appreciated the time we would sit around and talk about medical stuff from a different perspective. Dr. Shaw was also great to talk to. I honestly think she was the coolest doctor I've ever met. Haha.
I really appreciate my time at the diabetes camp. I admire the strength those children have. During a lot of the activities and during eating times the personalities of the children really showed. They were all unique. There are a couple of them that I remember and can call by name. If I had to chose my capstone site over again, I would definitely chose this site. I had a wonderful summer!

Camp Ho Mita Koda

It seems like yesterday I was at camp Ho Mita Koda. Time really flew by! It was a great experience. I've never been to camp so it was so new to me. Living in the woods, the bugs, the night time critters making noise in the dark, all new... I loved it though. I wasn't sure what to expect when I first arrived but as time went on, I became a part of the Camp community. The camp is for children with Type - 1 diabetes and has been around for years. I was excited t be a part of something so great. 
Our capstone group decided to teach the campers about the effects exercise has on the blood glucose level. I thought this was appropriate because the children are so active, naturally. When the children checked into the camp, within the first hours they are doing a swim test. I think teaching them about what happens to their body when they participate in physical activity is very important. It was interesting trying to make up lessons plans because I am not creative at all. We had to do some research on the topic and I found a lot of information. I was more familiar with Type - 2 diabetes. I think coming to the diabetes camp was very beneficial. 
We taught about exercise twice a week and to say I was nervous is an understatement. Speaking in front of people was already a problem of mind but try keeping the attention of children who just ate dinner and wants to get back to camp activities. Not an easy thing! Mary and I started off a little shaky but after getting feedback and tweaking a few things here and there, we got into the swing of things. I knew the next couple of weeks were going to fly I had to cherish every moment. 

Thomas McCafferty and J Glenn Smith Health Clinic

     At the start of my Capstone experience, my partner and I both had no idea what it meant to work with the "Cleveland Health Department." We were not informed about what activities we would be doing and what type of facility we would be placed at. We both were very excited to discover that our experience meant that we would be at STD and reproductive health clinics (both of which are sister clinics to the Free Clinic on Euclid Avenue). This meant that we would be acting as nurses in the clinic: administering medications (oral and IM), providing patient education, and addressing diagnoses with patients. I was honestly not looking forward to the Capstone because, from my prior knowledge, most of the "Capstone experiences" were not the type of public health I enjoy. Luckily, this one was!

     There are two clinics that my partner and I switched between: Thomas McCafferty Health Clinic at W. 41st and Lorain on the West side of Cleveland and John Glenn Smith Health Clinic at E. 111th and St. Clair on the East side of Cleveland. Both clinics are set up almost identically. The clinics are walk-in based, but also take appointments. The patients come in to a waiting room, are checked in by the secretary and wait for triage, where a medical assistant discusses why they have come to the clinic and takes their vital signs. The patient then has to have blood work done, if they have come for an STD screen. If they are just coming to the clinic for immunizations or treatment for a prior appointment or for a refill on birth control, they can come straight to the nurse. The nurse (me) then can complete TB testing, give birth control, or other medication if the nurse practioner has previously placed an order to do so. Then the patient can leave. However- if the patient requires a regular exam, the patient returns to the waiting room until the nurse practioner is ready to see them. The NP completes an exam, has the patient leave a urine specimen, and the NP then goes to the lab to check the samples she has taken (urethral or vaginal or anal swab) under a microscope to test for STDs. The urine specimen and a gram stain are sent to a lab for culturing (so the patient receives the final results 7-10 days after their visit- which is why they sometimes have to return to the clinic for treatment only). Finally, after the NP makes a diagnoses based on what she finds during that initial visit, the patient can see the nurse (me) for treatment and confirmation of diagnoses and for education. I gave patients a variety of every diagnoses in the STD world: positive for HIV, chlamydia, gonorrhea, syphilis, trichomoniasis, herpes, genital warts, and non-gonoccal urethritis. Not to mention informing the patients of non-STD related infections, such as bacterial vaginosis, yeast infections, and fungal infections. I also had to inform women whether they were pregnant or not, and provide information on resources if they had a positive Hcg test.

     This was extremely exciting at times and interesting- the patients were as young as 12-13 and as old as 77! I love working with a large variety of people, so hearing their stories was great for me. I'm very thankful that I had this experience and that I was placed at this clinic- it was definitely an excellent fit for me.

   

My time at CCBH

        Its amazing how fast the summer went by. It seems like just yesterday I was finishing up finals and looking forward to my week off before intensives. This summer has had its ups and downs but my time at CCBH was something I will not forget. The employees at CCBH were nothing but exceptional and this was a major reason why I consider my time at CCBH such a success. Right from the get go they were ready to teach us anything we wanted to know and they made every effort to give us the best possible experience. I was given the opportunity to experience things and work with individuals who not only enjoyed their jobs but were also dedicated to making a different. Seeing an autopsy was probably one of the strangest but most interesting things I have ever seen and without the help of the employees at CCBH it never would have happened. I also got to work with employees in the environmental section at CCBH. I had the opportunity to inspect restaurants for cleanliness and safety which was interesting to see and something I will probably never get to do again. If I could do it all again I would certainly pick CCBH as my capstone.

      

Time Flew at Camp Ho Mita Koda

    I cannot believe that my capstone experience at Camp Ho Mita Koda has come to an end. It was definitely a bitter sweet moment. I had so much fun being at camp and meeting all of the staff members and the children. They were all wonderful and really made my experience one that I will never forget. From taking care of the children to participating in camp activities, this was an experience that I will talk about for years to come.
 
    While at camp, I learned so much from the medical staff and from the children themselves. I already had prior knowledge about diabetes, but after having the experience that I had at Camp Ho Mita Koda, I am really confident in caring for a person who has been diagnosed with type one diabetes. The children were so open to answering questions and really helped me feel totally comfortable with caring for a person with diabetes. I know that the knowledge that I have gained from this experience will help me in my future endeavors as a practicing nurse.
 
   I am so thankful that I was placed at Camp Ho Mita Koda for my capstone experience. Not only did I gain more knowledge about diabetes, I also was able to practice nursing skills throughout the summer. I am very glad that I got to put these skills to practice and maintain my confidence in applying them. I am certain that everything that I have learned from camp will be very helpful to know throughout my nursing career. I had a great experience at Camp Ho Mita Koda, and would return for another summer of fun and learning without a doubt!
 

Reflecting on Camp Ho Mita Koda...

My experience at Camp Ho Mita Koda these past two and a half weeks has been extremely rewarding, and I cannot believe that it has already come to an end.  In the little time I was at the camp, I have learned so much from the kids, not only about diabetes, but about the challenges they face and the adversity they live with every day.  I knew going into this experience that diabetes was a serious disease and it takes work to properly manage it, but I didn’t realize how severely it impacts nearly every single aspect of life.  I have so much respect for the children I worked with this summer and now have a much greater admiration for anyone who lives with this disease (type 1 or type 2).

At Camp Ho Mita Koda, I also learned a lot about carb counting, types of insulin, insulin schedules and insulin administration.  I got daily practice calculating dosages and drawing up medications, and administering subcutaneous injections.  These are all valuable skills that I can use during during my clinical experiences in the hospital as well as throughout the rest of my career as a nurse.

My two main goals for my Capstone experience were to teach the nine to twelve year olds about diabetes management (as this was our project objective) and to also have fun in the process. I definitely think I have accomplished both.  I thought that the lessons that we taught about exercise went extremely well - much better than I originally anticipated.  I assumed that we would have a harder time keeping the attention of the kids long enough for them to learn anything, but surprisingly they consistently actively participated during the sessions.  Also, the preliminary results of our pre and post-tests show that the campers learned a good deal! 

Overall, I really enjoyed my Capstone experience at Camp Ho Mita Koda.  I got to witness a new aspect of  community nursing, learned a great deal about diabetes, and had a ton of fun with all the kids in the process.  I surely will not forget my time at camp and am very grateful to have had this opportunity.