Wednesday, October 31, 2012

Southwest General Health Center Part 1

           Southwest General Health Center, located in Middleburg Heights,  is where I have been for the past six weeks for Capstone. Southwest is a community hospital that has around 300 beds. It is very interesting being at a smaller health center, because I am so used to having clinicals and other experiences at UH and the Cleveland Clinic. The hospital here is like a breath of fresh air, everyone knows one another and is willing to do whatever it takes to help each other out. Brandon and I spend most of our time in an office with the community nurses. The unique thing about Southwest is that they have a whole staff fully committed to the programs put on by the community department. Many of the nurses alternate between doing screenings/information sessions around the community and the Transition Nursing Program.
          The Transition Nursing Program is a program that was recently implemented last May. There was a lot of reasons why this program was created. Starting this October, Medicare began penalizing hospitals if congestive heart failure patients were readmitted before 30 days post discharge. The transition nurses at SWGHC identify patients with heart failure while they are in the hospital, and ask them if they would like to be involved in the transition program. This entails a home visit three days after the patient is discharged. During this visit, the nurses go over the patient's medications, and teach them all about their disease so they know when they need to call/visit their physician. After all questions are answered, the nurse leaves the patient with a scale so they can keep track of any weight gain or loss. For the next 30 days, the patient is called on a weekly basis to check in and make sure everything is going well. These interventions by the nurse helps ensure that the patients are not readmitted to the hospital, and therefore, the hospital benefits by not receiving any financial consequences. This is what our capstone project will be focusing on, and we are very happy with the results we have found so far!
        The amazing thing about the community department at SW is the amount of programs that have been created. Other than the transition nursing program, Southwest has a program for school nurses, a Neighborhood Care Free Clinic, and offers bone density, glucose, cholesterol, and BMI screenings free of charge at local organizations. There are several program for the geriatric population, for much of the surrounding area is elderly. A geriatric assessment program and Gatekeeper program benefit this population greatly. The Gatekeeper program identifies at risk geriatric patients that may need help in the community with activities of daily living, and training programs are scheduled for community members so they know just exactly what they should be looking for. All of the ladies that run these programs are wonderful.
        Brandon and I have been lucky enough to be involved in not only the Transition Nursing Program, but all of the programs that I just mentioned as well. Going out into the community allows me to come in contact with older adults, which I have missed since working in pediatrics for the last year. The community department has been extremely helpful with setting up visits and involving us with their different events, and they are very excited to see our final poster and project!

Saturday, October 27, 2012

Catholic Charities Free Healthcare Center: Pittsburgh, PA

"Good Morning. Did you have a good weekend?" Asks the security guard at the Catholic Charities building.  After an exchange about our mutual love of hiking in the fall weather, I walk up to the third floor of the Victory Building where the free healthcare center is located.  I begin my day by looking at the schedule- it jam packed. We've got ent, gyn, dermatology, general medicine, and cardiology.  That means I've got to do some rearranging of our specialty carts. After a brief chat with one of the volunteer nurses, we make a game plan, and I begin rearranging the rooms to make that happen.  While I'm doing this, the volunteer nurse is preparing our schedules and starting morning paper work.  Then we both verify the flu vaccine vials match our consent forms- these flu vaccines were generously donated to the clinic by tow of the volunteer physicians.  Now are first patient is here, so off I go to escort him back to one of the exam rooms.  i obtain a set of vitals find out their chief complain, and get a but of medical history.  The physician this patient is seeing is a resident from one of the local hospitals who rotate through the clinic for a couple of weeks, so the more information about the patient I can share with her the better picture she'll have since she doesn't follow this patient long term.  After speaking with the patient, I go present the patient to one of the pharmacy students working at the clinic who then sees the patient.  While the pharmacist is doing this, I speak with the physician about the patient, and chart my assessment in the EMR.  Now I'm off to help another physician with some computer problems before taking another patient back to the exam room.  "Tracy, Ive got a question for you about this patient you just had me see." says the resident.  After talking for about about his plan of care, we both realize we need a pharmacist to assist us, so we walk across the hallway to the pharmacy work room. These conversations are one of my favorite things about working in the clinic- real interdisciplinary collaborative work!  After revising the plan of care, I begin preparing orders for lab work and x-rays for the patient before explaining to him how he can go about getting these at no or little cost.  While I'm doing this, one of the volunteer nurses has finished up with the other patient I saw this morning.  now that my two patients are discharged, I go back to the nurses station to see if anymore patients have arrived. After seeing several more patients in a similar fashion to the first patient I saw, its time for lunch.  I'm working with the gynecologist this afternoon which is nice because you have more time with each of your patients and you're not trying to juggle the needs of four patients and four doctors.  By the end of the day, I'm ready to clean up, pack up, and go home to reflect on all the things I learned that day.  It never ceases to amaze me how much there is to learn.  I've included a photo of Nicole, the other FPB student, and I with two of the volunteer nurses.

Wednesday, October 24, 2012

Catholic Charities of Pittsburgh Free Healthcare Clinic

The Catholic Charities of Pittsburgh Free Healthcare Clinic has been a wonderful and positive experience so far. The building, located directly downtown, has a great operating system run by mostly all volunteers. There is an eligibility office on the 6th floor for members looking to join the services offered and then the dental and medical rooms are on the 3rd floor. I continue to be amazed at the services that are provided by the Catholic Charities Clinic all free of cost to the patient. Specialties offered include ophthalmology, endocrinology, cardiology, dermatology, gynecology, urology, physical therapy, and much more. The volunteers here bend over backwards using these services to make sure these patients are cared for and taken care of free of charge. Labs such as blood draws are free through Quest laboratory. Even every effort is made to get free/cheap prescriptions from the Giant Eagle Pharmacy’s $4 and $10 dollar program. I have yet to work with the dental aspect but I know they offer cleanings, exams and x-rays, extractions, fillings, root canals, and some oral surgeries.  
            The clinic here is open roughly 9am to 4pm Monday through Friday. Every first and third Monday the clinic provides evening hours for the patients who work and cannot get time off from 5pm to 9pm. Tracy and I arrive to the clinic in between 8am and 830am to turn on lights and get organized for the day including printing off patient schedules for each doctor. When patients arrive the front office, again staffed of all volunteers, will mark the patients here in the computer and one of the RNs, Tracy, or myself will call the patient back to one of the 4 medical exam rooms we have. There we will get a height, weight, past medical history, and their chief complaint. We then will go to the pharmacy which is composed of a Duquesne clinical instructor and 3 students going through their 6 week rotation here at the clinic and tell them about the patient we just took back. Pharmacy then will go back and meet with the patient to reconcile their medication list and answer any questions they might have pertaining to their medication. While pharmacy is back with the patient the RN will then go report to the doctor who will see the patient once pharmacy is done.
Patient visits are scheduled for at least 30 minutes sometimes even an hour so a lot of teaching can be done. Our capstone project involves exactly that, teaching and implementing an intervention that RNs can easily use to improve knowledge of patients. The biggest problem that Tracy and I have seen at the clinic is obesity. BMIs are in the 30s and 40s. Patients are just uneducated on the correct diet and lifestyle changes that are needed to live a healthy life and get back down to a healthier weight. We plan that by using an intervention that is approved by RNs at the clinic we will increase patients’ knowledge of healthy lifestyle choices.  We will evaluate effectiveness of our teaching with a pre and post test.
To this point my experiences have been wonderful. I continue to learn from the doctors and RNs who volunteer their time and services to make sure the underserved population around Pittsburgh receives healthcare. The patients are so thankful to everyone who gives their time to the clinic. The patient population is great to work with because they are willing to listen and really listen to what you are telling them about their health. We at the clinic are these patients’ primary healthcare facility and I am proud to be part of it. Even after I graduate I hope to be able to donate some of my time to organizations like the Catholic Charities of Pittsburgh Free Healthcare Clinic.

Lorain County General Health District Capstone

           My capstone experience at Lorain County General Health District has been very positive. The entire staff has really put forth effort to ensure that my partner, Patrick, and I are introduced to every community health resource and program. We have had the opportunity to speak with staff from environmental services, communicable diseases and the Women, Infant and Children (WIC) program. Also, we were able to participate in home visits and flu/immunization clinics. The home visits include newborn visits, Bureau for Children with Medical Handicaps (BCMH), and Children Services. These visits in particular have had one of largest impacts on me. It is truly a privilege to be invited into the homes of strangers, for lack of better word, and actually trusted with their health. I’ve met a lot of great families and individuals. Patrick and I even got invited back to a home anytime we would like! The flu clinic was also a memorable experience. It provided a slightly different angle to public health, the completely preventative side. It was impressive how many people showed up to the clinic, allowing us to meet a variety of people from Lorain County. I’ve never given so many shots! The setting was very interesting as well. We were in Wellington at the fairgrounds in a barn-like building. A horse was even racing around the track while nurses gave flu shots outside in the “drive-thru,” only public health.
On a different note, our capstone project is coming along well. We are working with the Adult Health Clinic. The population is the 55 and older individual. It is a free service that is usually operated by two Registered Nurses (RNs). What a fun experience! Patrick and I have really bonded with the RNs that primarily work there, making for an extremely comfortable environment. We are able to learn from them and speak openly with them about our time here at the health department. As for the population, I hope I age as well as them! Our project is about medication reconciliation and documentation. It has been quite the interesting journey arriving at that topic; however, working with the staff, management and faculty we were able to come to an agreement that will benefit the Adult Health Clinic and their clients. Recently, Patrick and I have completed the post survey and are concentrating on completing a proposal for documentation.
Prior to the Lorain County Health District, my only exposure to public health was working with the Cleveland schools. This experience is allowing me to expand my knowledge of what public health is and how nurses play a role in it. I’m excited to have the next half of the semester with this staff and community.

Otis Moss Jr. Health Center

My experience in Cleveland has been going good so far. I have adjusted well to the surroundings thanks to my roommate Loni. Being on vacation and living in a new place is so different. Loni was able to find the different information we needed so that our experience would go smoothly and not be noticed as a tourist everyday. When I came to Cleveland, I came for the experience and to be part of someone else culture. I have adjusted well to the Cleveland culture and made some adjustments to my own.
My capstone experience is taking place at the Otis Moss Jr. Health Center on 89th Quincy Ave in the Fairfax Community. This center provides Pediatric, OBGYN and Adult care services. I am enjoying my experience thus far because it is an environment I am familiar with and can relate to. My first day at the center, I was given a brief introduction to the pediatric floor about their daily functions and procedures. Their daily functions include assessment, laboratory testing (cholesterol, vitamin D), and immunizations and follow up calls. After the introduction, I immediately started taking care of patients and helped out the staff in anyway I could have. It was pretty interesting at first dealing with kids but I got the hang of it and found little tricks to get them to cooperate. I discovered that many of the pediatric patients that frequent the center have been coming there from their time of birth. Some patients have been coming for at least 21 years. 
            The people that frequent the Otis Moss Community makes the experience even better because of the many personalities I interact with daily. Even the noncompliant patient makes you think out of the box sometimes. 
 The capstone project we are currently working on is a Diabetes Education Program to help patients manage the disease more effectively. Our biggest concern for this project is having a good patient turn out. Apart from that everything is going as plan. In all the experience at the Otis Moss Center is going well. 

Lorain County General Health District

The Lorain County General Health Department has provided many opportunities since starting in September.  Morgan and I have been involved with newborn visits, child services visit, immunization clinics, WIC, communicable diseases, environmental services, the Bureau for Children with Medical Handicaps (BCMH)  and the adult health clinic.  Initially, we worked at the health department in order to understand the operations of community heath at a health department.  We used the first two weeks primarily to do home visits for newborns, children's services and BCMH visits.  In this time we established that we are going to be working with the adult health population for our project and for the majority of our community health capstone.

The second week into our capstone rotation, we were involved with our first immunization clinic at the health department.  This was particularly good training for the upcoming flu clinic that we were involved with at the Lorain County Fairgrounds in Wellington.  At both of these clinics, the staff members at the Lorain County General Health Department have been very welcoming and have helped ensuring that we are comfortable with what we are doing. 

The Adult health Clinic has been a very good population to work with over the past few weeks.  We started with a potential identified problem of medication adherence and through surveys, we have determined that the medication issues that are current problems are not with adherence, rather the lack of a consistent and feasible documentation method.  Through our survey and interactions with the clients and nurses, we have found a plan to improve the way that medications are handled at the Adult Health Clinic.  With evidence based practice showing that brown bag methods of determining how and what medication patients are taking, a seasonal schedule for assessing.  We have also creeated a new screening tool for every appointment in order to quickly identify risks for medication non-adherence and also as a way to ensure that resources that may be needed are being allocated appropriately.  We have also had the opportunity to address resource needs in order to make the implementation of this plan a success.

The semester at Lorain County General Health District has been a positive experience so far and I am eager to continue working with the Adult Health Clinic and make an impact in the care that is given with medications.

Otis Moss Jr. Health Center

     My time at the Otis Moss Jr. Health Center (OMJ-HC) has been good. Upon arrival I was more anxious to see the community, the facility, and meet the staff and patients. This health care facility is located in the Fairfax Community which is predominantly African Americans. This community has two special characteristics, the elderly and/or retired individuals who have a strong religious faith. Every block at least has one church. Obviously like many other communities throughout the state of Ohio and nationwide, this community has experienced a downward turn in the economy. However
over the past few years local and national development groups have been rejuvenating this community.

     The OMJ-HC is a satellite, outpatient community health center for the University Hospitals. It was established in 1997 by an African American, Reverend Otis Moss Jr. and the Olivet Institutional Baptist Church which is across the street. They not only serve the residents in the Fairfax community but also provide care to anyone and everyone. This cozy and small two story building houses various specialty areas such as primary care, obstetrics and gynecology, pediatrics, and podiatry. It currently employs a staff of fourteen. It offers various educational health prevention and management classes and participates in many local health fairs and seminars.

     Since I am from the island of St. Thomas (STT), United States Virgin Islands (USVI) OMJ’s small setting was one of familiarity and ease. Having and keeping an open mind about the patients community, cultural, educational, and social facets allows for me to adapt. They were many similarities with this facility compared to those in my native home. These similarities are simple things such as greeting someone or a room filled with people by saying good morning and common courtesy and respect in all interactions between staff and patients.

     The USVI is made up of four islands and a few cays. There two major hospitals (STT and St. Croix (STX)) and one clinic (St. John (STJ)). Transportation between these islands is either by air or sea. This has created us to become very efficient in providing optimum health care. I also see a duplicate within the OMJ-HC because it is a unique one-stop shop in this community. At this moment we are preparing to host three diabetes classes for our capstone project. Over the past few weeks I have enjoyed and learned a great amount of historical information about the OMJ-HC, the community, and the city of Cleveland. 

Tuesday, October 23, 2012

Virgin Islands Part 2

My time in the Virgin Islands is flying by, with less than four weeks left I feel there is so much more I want to do and learn!  I then think how much I have done since I have been here.  I have experienced a new culture in a way that I never thought possible.  I understand more about the culture and the people who live on the islands.   Today I went to the only mall on St. Thomas.  The mall had about ten stores, two restaurants in the food court and was attached to a Kmart.  I went looking for a Halloween costume and was lucky enough to find one at Kmart. 

                When I asked my friends who live on the island if they celebrate Halloween, majority of them say no.  One girl said she usually watches the ABC Halloween special on TV with her family to celebrate Halloween.  When I told her that I used to trick or treat she was shocked.  “I didn’t know people actually did that,” she said.  Besides Halloween I have also learned other things about the culture here.  I learned that newspapers are not delivered to homes every day.  If someone wants a newspaper they have to buy it either at a store or someone on the street.  There is also not a garbage pick-up every week.  When someone wants to get rid of their trash they have to take it to a dumpster that are located around the island and the garbage trucks will pick the trash from there.   These are a few culture facts that I have learned while being on the island.

                One of the classes that I am enrolled in at the University is snorkeling.  We have class every Monday for two hours.  This was the first and so far the only class that I have ever had to wear a bathing suit to class.  The first test I had for the class was a swim test.  At class this past Monday, we took a boat trip to a small key.  While snorkeling we saw a puffer fish and a lot of jelly fish!  Everywhere I looked there would be more jelly fish.  My instructor then picked up a jelly fish and I was able to touch it.  I learned that only the jelly fish’s tentacles will sting.  I was still very afraid of the jelly fish even though I touched one. 

                My clinicals are going well.  I have learned many new things from my patients and how they view health care, especially with the election going on.  On St. John there is no hospital only a clinic that works as an urgent care, pharmacy, and many families primary care resource.  After having clinical in Cleveland and being exposed to so many different hospitals, it is weird to think that there is no hospital on St. John.  If someone needs to go to the hospital they have to take a ferry to St. Thomas.

                I have learned and experienced so many new things.  I am excited for the last four weeks of my adventure in the Virgin Islands!