Monday, July 30, 2012

Camp Ho Mita Koda

   Arriving at Camp Ho Mita Koda for the first session of my capstone experience caused a mix of emotions. During our undergraduate nursing career, we are taught so much about diabetes that everyone would think that we are all experts. After the training week here at camp, I realized there was so much more to learn about this disease. I was nervous to work with the children here at camp, but also excited because I knew I was going to enjoy my experience.
   During the training week, we learned more about diabetes in a very short amount of time. It was very confusing at first, because there was so much information presented to us in such a short amount of time. We were introduced to insulin pumps, and got a basic training on how to operate them. We learned about insulin,  the importance of having a healthy diet, carbohydrate counting, and so much more during this short week of training. However, the real learning started the day we arrived at camp for the first session, when the children were able to explain and show us everything that we asked them about.
   After the first day here at camp, all of my nerves disappeared. The children here are so smart and love to teach everyone about their diabetes. Any questions that we had, they had an answer and an explanation. It was nice to get information from someone who lives with diabetes and has been managing it for most of their life. I was able to learn a lot more about the insulin pumps which were new to me. The children who used pumps were very helpful and explained every step in order to deliver their dose of insulin, so I feel that I am comfortable with using them. After the first session of being here, I feel that I have learned so much more about diabetes and am so glad that I got to learn from these children.
   Not only do the chilren teach us about diabetes, we are also here to teach them. We have been providing educational sessions to the children about exercise and diabetes management. The sessions have been going very well, and the children seem to be responding in a postive way. The children love to learn from us just as much as we like learning from them, as they are very attentive and focused on learning as much as they can during our short sessions. Camp Ho Mita Koda is a great place for the staff and the children to learn about diabetes, and I know that I will take what I have learned here and apply it in the future.

Sunday, July 29, 2012

Missing Camp Ho Mita Koda Already

Wow, I can’t believe my capstone experience is already over! Chavon and I had some ups and downs at Camp Ho Mita Koda but the overall experience was extremely worthwhile. We had the opportunity to teach about exercise as we thought that the kids had limited education about this topic. Being at a camp, where their blood glucoses were performed more often and closely monitored showed us that physical activity allowed for better diabetes management. Overall, the kids benefited from learning about aerobic and anaerobic exercise. I felt very fulfilled following the children through the teaching process. Chavon and I made a huge difference in the kid’s exercise education from what we observed in their pre-test and post-test scores.

My favorite week of camp was the last week. I think that Chavon and I learned the most during this week, related to pump site changes, pump rate changes, and the different aspects of insulin. Also, since we were not distracted by learning the protocol, it was easier to form relationships with the campers. We had a lot of fun getting to know the campers, whether they were young or adolescents. It was enjoyable to hang out with the counselors as well.

I still think about Camp Ho Mita Koda and at times wish that I had a few more weeks to spend there. I found the capstone experience in general very rewarding since we were very hands on. We performed medication calculations, administered insulin and other treatments, and used critical thinking to solve issues. I felt fully involved at the camp and applied many of my nursing skills. I thought that being exposed to camp nursing was also beneficial. Since I will most likely be working in a hospital setting, it was interesting learning about different types of nursing outside of the classroom. Kids came to the nursing staff with ear aches, blisters, upset stomachs, and Staph infected mosquito bites. It was interesting to see this spectrum of first aid. I will still be able to apply much of what I learned at camp to whatever discipline I work in. 

In the Wild at Camp Ho Mita Koda

My capstone site at Camp Ho Mita Koda in Newbury, OH is for children with Type 1 Diabetes. The camp sessions usually span Sunday to Thursday, but for older kids there is a 2 week session. The focus of the camp is for children to have fun participating in activities while adequately managing their diabetes. Our first week was training. We got to meet the other nurses we would be working with along with the counselor staff. I had never been to a camp before besides one overnight for girl scouts. So living in a cabin with three other girls and no air conditioning or attached bathroom facilities, would definitely be an experience. I was looking forward to “roughing it” though.

The first actual week of camp was an adjustment as many of the staff was new and policies had been changed since the last summer. Every day was a chance to learn related to prioritizing and flexibility. My classmate, Chavon and I operated by the principle, “just go with the flow”. Once a few days went by and we went to various activities with the kids, the treatment policies became easier to remember. Also, we participated in a variety of the activities with the kids, such as boating, pool time, drama, archery, and sports.

While at home, most of the kids are not involved in as much physical activity. Many of the parents worry about their kid’s blood glucose management while exercising. Thus, the parents end up restricting a majority of physical activity that kids would most likely benefit from. We asked one of the campers what he does at home for fun. His response was “play video games…my mom doesn’t like me playing outside because I get low”. This informal encounter really showed Chavon and me the effect of diabetes on a child’s life.

I’m looking forward to the weeks at hand. I think it is a lot more beneficial to learn about diabetes or any other disease from a primary source, instead of a lecture. Assimilating into the camp “culture” definitely provides us with a different perspective of diabetes and how it affects individuals. 

Saturday, July 28, 2012

Great Lakes Home Healthcare and Hospice

As my capstone experience at Great Lakes Home Healthcare and Hospice in Erie, Pennsylvania has come to an end, I feel as though my fellow classmate and I have successfully partnered with both the agency and the surrounding community. The agency was welcoming and offered much guidance and support as Paulina and I identified the major public health issue in the community and began to implement our project to address it.

With ample time spent in Erie, Paulina and I noticed that a large number of residents smoke cigarettes. Knowing that smoking harms nearly every organ of the body, we decided to create a brochure that would increase the community’s knowledge of the health effects of smoking as well as secondhand smoke, and the risks associated with smoking and oxygen therapy. The educational brochure was handed out to 120 patients during a home healthcare visit after the patients completed a twelve-question pre-survey. On the following visit, the patients completed a post-survey consisting of the same twelve questions. Although we have not analyzed all of the results from our project yet, those that we have suggest that overall, the patients' knowledge regarding tobacco use has indeed improved. I was surprised at the number of patients who in fact read our brochure. This makes me very optimistic that with continued use of our brochures, the agency could ultimately reduce this public health priority.

The staff at Great Lakes Home Healthcare and Hospice was so grateful for the opportunity to have Paulina and I at their agency. They speak so highly of Case Western Reserve and Frances Payne Bolton School of Nursing. The director of the agency told Paulina and I that we truly rise above all other nursing students that have came through their door. It is quite an honor to be thought so highly of and we are very thankful to have been given the opportunity to have our capstone experience at their agency. Paulina and I utilized many of our nursing skills and gained useful knowledge to help us in whatever career path our future may take us. Speaking on behalf of both Paulina and I, we highly recommend continuing to partner with Great Lakes Home Healthcare and Hospice for future capstone experiences. 

Great Lakes Home Healthcare and Hospice, Erie, PA

My experience at Great Lakes Home Healthcare and Hospice in Erie, Pennsylvania has come to an end.  I can't believe how fast time flew by! My time at this agency has been amazing and has provided me with great experiences that I will cherish and look back upon during my future career as a nurse.  The staff at Great Lakes was very welcoming and supported Ashley and I throughout our time with them.  Ashley and I had the opportunity to work with med/surg, mom/baby, and wound nurses, which allowed for us to work with patients throughout the entire life spectrum.  Our nurse preceptors provided us with endless hands-on opportunities which have allowed me to improve the nursing skills I have learned thus far as a student. For example, this summer I have been able to complete countless wound/wound vac dressings, change and insert Foley catheters, perform picc line dressing changes, and insert IVs, along with many other skills.

 During our time visiting patients in their homes, Ashley and I noticed that many patients are current cigarette smokers, and several of those smokers were receiving oxygen therapy.  Knowing how dangerous combining smoke and oxygen is, Ashley and I decided it was best to to focus on educating patients the dangers of it and how smoking causes serious health effects.  Ashley and I wanted to improve patients' knowledge regarding the topic so we administered 100 pre-surveys consisting of 12 multiple choice and true/false questions.  We then gave patients brochures that were created by us that outlined important information regarding tobacco use.  At the next home visit, patients were given a post-survey, that was identical to the pre-survey, to see if the patients' knowledge on the topic improved after they were given time to go over the brochure.  We are still waiting for the rest of the results to be returned, but we can infer from the surveys that were handed back that the majority of patient's improved their knowledge. 

Overall,  Ashley and I believe that this clinical site was wonderful and provided us with an amazing experience.  This Capstone site is recommended for everyone!  The clinical director, Ms. Cheryl Cook, has nothing but great things to say about us FPB students and hopes that the school will continue to send students next summer.  I am sad that the time has come to its end, but am excited to perform the skills and use the knowledge I have gained in my future experiences!

Friday, July 27, 2012

Healthy Women, Healthy Lives---The Experience

   With Cincinnati as my hometown, I thought I knew everything there ever was to know about this city. I was wrong. Working for the Healthy Women, Healthy Lives Program, I discovered much more about the city of Cincinnati and now have a greater understanding of public and community health. For this capstone, Deena and I would travel to community centers, such as clothing and food pantries and community health clinics, and go door-to-door in impoversihed neighborhoods to spread the word about upcoming women's health screenings for Healthy Women, Healthy Lives (HWHL). Working within the community, we learned about our patient population. In the hospital setting, we often only think about treating the patient's diagnosis, rather than seeing how social or environmental factors within a patient's community might affect their health. By listening and interacting with local residents, we learned how factors within one's neighborhood can be detrimental for the members of a particular community. Thus, it is important to look beyond the diagnosis and instead treat the patient as a whole.
   For our capstone project, Deena and I chose to put together a de-stress program, "De-stress Express", which we held at a local church in the Madisonville community of Cincinnati. We had about 19 women attend the program. Our main objectives were to educate and teach the women about stress, how stress negatively affects one's health, and how stress and menopause are interrelated. During this program, we offered and demonstrated two ways for women to cope with their day-to-day stress--yoga and guided imagery. We experienced great success and saw a reduction in the women's stress levels and an increase in their knowledge about stress & health, menopause & stress, and ways to cope with stress. Due to the success of our program, HWHL plans to offer a free yoga class at the church to improve the mental, physiological, and emotional health of local women!

Healthy Women Healthy Lives

I can't believe that my capstone experience in Cincinnati is already coming to an end. Elizabeth and I only have a couple more days left to pull together the rest of our projects before we head home. I have learned so much about the Healthy Women, Healthy Lives Program. The organization and preparation that goes into planning each health screening event is incredible. Copying charts, sending out "Save the Date" cards, calling women to make appointments, preparing gift bags, it felt like the work was never-ending. The hardest part about the planning the events is getting the information about the events out to the community. We went to the communities to give out flyers at the grocery stores, food pantries, salons, barber shops, libraries, community centers, and sometimes we went door-to-door and handed out flyers. Being able to see the communities where the women are living has been an eye-opening experience. We went into one store and a woman was very thankful when we told her about the health screening event in her neighborhood. She explained that there were about 30 women that slept behind her store every night because they had nowhere else to go. We also saw countless homes that were abandoned and boarded up. The days we went into the communities were my favorite. It was so nice to be able to get out of the office and interact with the community. 

For our capstone project Elizabeth and I went to the community where we had just finished a health screening event with Healthy Women, Healthy Lives. We taught a class of about 19 women about stress, how stress relates to menopause, how stress relates to health, and how to relieve stress. At the end of the class we had the women perform two stress relieving activities, yoga and guided imagery. I think it went great! All of the women participated during the discussion and appeared to enjoy the activities. We gauged the women's stress levels and knowledge about stress, menopause, health, and ways to relieve stress with a pre- and post-survey. The results showed that the overall stress level of the class decreased and the women's knowledge increased, so I feel that our class was a success! 

Thursday, July 26, 2012

Great Lakes Home Healthcare and Hospice, Erie, PA

            Before the start of my senior capstone experience at Great Lakes Home Health and Hospice in Erie, Pennsylvania, I experienced nervousness as I did not know what to expect and what was expected of me as a student.  In the past whenever I thought of home health nurses, I pictured an older nurse visiting patients in their homes assisting with activities of daily living and taking vital signs.  I soon learned that this is not the case.  The first morning of my experience I went to the main office to meet with the director of nursing for the company.  She was very welcoming, told us about the company and introduced myself and my fellow classmate to everyone in the office.  The director made us feel very comfortable and our nerves were easily forgotten.  Our preceptors met with us, gave us a brief overview of their typical days with patients and then we were off to meet with our first patients. 
            Only two patients were scheduled for the rest of the first day since it was already after noon.  We walked into the first patient’s home and the strong smell of cigarette smoke filled my nostrils.  In the recliner chair was a woman in her seventies smoking a cigarette with a dog on her lap.  Old newspapers, cigarettes, and boxes of cereal surrounded her.  I did not expect what I saw in front of me going into this experience.  My nurse and I had to move dog toys, clothes, and magazines in order to sit on the loveseat and get organized.   Basic medical care was performed with every patient as well as a full head to toe assessment.  The only aspect that was different from what I imagined was the patient’s environment.  I was used to walking into a patient’s room in the hospital which is a controlled environment that is constantly monitored.  With home health, the care provider does not know the majority of the time what they are going to see or experience when they walk into a patient’s home.  Throughout this senior capstone I may experience many different situations that may make me uncomfortable but in the end it may help me develop more into a well-rounded nurse. I am excited for what this experience has to offer!

Tuesday, July 24, 2012

The Family Planning Clinic at CCBH

           The Family Planning Clinic, located within the Cuyahoga County Board of Health, is open every Tuesday and Wednesday from 2:00 pm till 7:00 pm. As  a student interning at CCBH I spend hours each week working and observing within the clinic. The services offered here include: STD testing and treatment, prescription birth control, education and counseling. The services are available to men and women of child bearing age, which is over 13, and no one is turned away for financial reasons. The clinic treats clients on a regular basis who lack health insurance and many not have anywhere else to go. As far as patients who do have insurance they can chose to charge their insurance or pay in person based on a sliding scale related to their income  The distinctive and often inexpensive services provided at the clinic bring in people from all over Northeast Ohio. Some turn to the clinic because of financial reasons others because of the discrete treatment offered here.
         The diversity of the client population makes working here a very interesting experience. Each patient is different and has his or her own unique story. The first few days in the clinic were used as an opportunity to shadow other employees. I was astonished at how good the nurses were at making the patients feel comfortable. Over the last few weeks I’ve slowly become more comfortable working in the clinic. I’ve begun to really appreciate the services  here and the exceptional care the facility offers. The experience I gained working in this environment is something I will carry with me for a long time to come.

Reaching the final week at CCBH

As I see the near end of my capstone experience here at Cuyahoga County Board of Health (CCBH), I feel somewhat regretful that I did not do enough outreach, home visits, and more involvement with a variety of projects that expands beyond nursing to community health and environmental science. However, in the end, I can say confidently that I had a fruitful and rewarding capstone experience where I gained a deep insight and greater understanding to the role public health plays to meet the needs of the community. I was able to reflect on my nursing practice, personal and professional view and values. My perception of public health dramatically expanded and my time here allowed me to have a greater appreciate for this field of nursing. I felt encouraged, knowing that there are passionate individuals who works in public health with the pure purpose to meet the needs of the community.
My group and I attended HIP-C (Health Improvement Partnership Cuyahoga) meeting and observed the attendees discussing the Forces of Change Assessment. We got involved with designated groups as reporters -- I was assigned to the technological group. I was amazed by the intricate process and the level of interdisciplinary group effort to identify the trends, factors, and events, as well as the downfalls and opportunities created. I was encouraged by the collaborative effort to increase the quality of health care for the residents of Cuyahoga County, and truly make a difference. 
We did our Tri-C outreach -- coincidentally, it was during Student Orientation, so we had a frequent flow of new students going to the Counseling Office -- our booth was located right next to the entrance of the office. We continued to man a booth with condoms and informational resources (tri-fold, handouts, pamphlets, business card for the clinic, etc). We also gave away a goodie bag, filled with a condom, pocket-sized handouts, and information about sexual health topics such as STDs. It was an interesting experience because of the interactions I had with a variety of people and their curiously with our outreach effort. I have noticed that females were more willing to talk with us, ask questions, and voice their curiosity and interest with the services that Family Planning Clinic offers for free or low-cost. The males were more interested in the free condoms; although, there were a few older men (fathers) who wanted to know more about the clinic and/or took the pamphlet about sex talk with the youth. More so, I was pleased with some of the people's response and their earnest interest to check out the Family Planning Clinic at CCBH. After all our efforts to doing outreach in the community (Lakewood) and Tri-C West, I am glad to see that we were able to reach our target of increasing the awareness of the Family Planning Clinic and of the Medicaid Waiver. 

Friday, July 20, 2012

Experience at Cuyahoga County Board of Health (CCBH)

My experience at the Cuyahoga County Board of Health (CCBH) in Parma, Ohio has been perceptive, educational and thought-provoking. During the orientation date and since then, we were warmly welcomed and accepted by the staff of CCBH, particularly the nurses. Within a short period of time, we have integrated ourselves as nurse interns of CCBH and were provided a variety of opportunities to collaborate with them in several public health-related projects (i.e. environmental science and sanitation visits) and patient-interaction through the family planning clinic, the immunization clinic, and the travel clinic. I was able to witness and observe the wide range of what public health nurses do in terms of meeting the needs of the community. 

I am involved with the Family Planning Clinic, and had had observation days in the immunization clinic and the traveling clinic -- shadowing my preceptor, the physician, public nurses, and meet and interact with the clients. In the immunization and travel clinics, I learned different facts about vaccines, recommended vaccines if traveling out-of-state (specific to country and client-specific), and how to deal with a wide array of patients. It was definitely a eye-opening experience, especially dealing with patients from a physician's perspective and a public nurse's perspective. For the majority of the time, my group and I worked on publicizing the "My Life, My Body" Family Planning Clinic and educating the clients (if uninsured) about the Medicaid Waiver to help reimburse the clinic. The Family Planning Clinic provides services at low-cost (based on sliding scale) or free -- services such as birth control, HIV/STD testing, pregnancy testing, reproductive health education, etc.  By shadowing my preceptor, I am also now more aware of how sensitive the topic of sexual/reproductive health is as well as how crucial and important public health is. I observed and applied the skills of handling all kinds of topic in a sensitive and appropriate matter, for example, contraceptives, STI testing and treatment, HIV testing, pregnancy testing, PAP smears and sexual health education.

My favorite experience thus far was doing newborn home visits. The public health nurse I was paired up with was very friendly and approachable. It was such an intimate experience because the nurse and I were able to have a close and personal interaction with the clients. When the nurse and I went to a client's home for a newborn home visit, I was able to see the follow-up care -- vital signs from the mother and the baby, physical assessment of the newborn, and post-partum depression risk assessment. It was such an amazing opportunity to see the interaction between the nurse, the baby, and the mother, sometimes the father. Also, I was surprised by the educational component of the home visit -- many mothers have questions and need resources for her family and newborn -- this program is great for low-income families because the nurse provides additional resources and ways to get resources for free.

As part of our outreach efforts, my group and I are currently advertising Family Planning Clinic at Tri-C western campus -- we have set up a booth by University Counseling office. Our shifts are 10AM-2PM and 5PM-7PM. By outreaching at a community college, we aim to increase awareness of the services that CCBH offers.

I am consistently surprised by the large spectrum of responsibilities that the CCBH has. I am so grateful for the people who work here -- because of them, the community's needs are met and/or handled.