Tuesday, December 25, 2012

Angoon, AK

About six weeks into my time at the Juneau Public Health Center I was given the opportunity to go on a trip to Angoon, a small native village of less than 400 people, with the itinerant nurse. The trip was shorter than originally anticipated because the itinerant nurse was moving to work in Anchorage and be an itinerant nurse for communities in the Aleutian Islands. In Southeast Alaska, many of the communities are not connected by roads so we took a float plane from Juneau to Angoon. Taking off and landing on the water in a plane whose maximum capacity is 6 people was a very different experience than the commercial flights I was used to and on the way to Angoon we were able to see a humpback whale swimming below use.
            Once in Angoon we stopped at the SEARHC (Southeast Alaska Regional Health Consortium) clinic and dropped off our things before going around to the different schools on the island to follow up on students who needed immunizations and ask what their health needs were to pass on the information to the next itinerant nurse. That night we were invited over to dinner by one of the women who worked at the health center and had “adopted” the itinerant nurse into her family. For dinner we had Coho salmon eggs, seaweed and smoked salmon so I had the opportunity to try traditional Alaskan foods.
            The next day we held a shot clinic to help children catch up on their immunizations and receive their flu shots for the year before we flew back to Juneau. The pictures below are: a view of the water and dock from my the room where I stayed and a view of Angoon from the float plane on our way back to Juneau.

Juneau, AK

Before leaving for Alaska I was excited but also rather anxious. However, all my fears were completely unfounded. I was able to connect with another FPB graduate who is a flight nurse in Juneau and he helped me find housing with a nurse practitioner and picked me up from the airport. In addition to him, there is another Case FPB graduate working at the Juneau Public Health Center where I was based and it was really nice starting off in Juneau already having a support system in place.
            Having spent my life in a variety of large cities my three months in Juneau was the first time I experienced life in small town (Juneau has less than 32,000 people) and I was impressed by how friendly and welcoming everyone was.
            In the public health center, I was able to get involved with the Juneau Breastfeeding Alliance and the Juneau Youth Domestic Violence Prevention Coalition. I was impressed by how many professionals from Juneau got together to serve the community and address community issues.
            I was also given the opportunity to work with a few LTBI (Latent Tuberculosis Infection) patients, something you are not really exposed to in the contiguous United States. The national rate of TB in 2010 was 3.4 cases per 100,000. Comparatively, Alaska has 9.3 cases per 100,000, over twice the national average. Despite Alaska being a part of the United States it does have a very different feel and the health issues present and how they are dealt with are often very different.
            While, in Juneau my sister was able to come visit and we were able to go on a boat tour to Tracy Arm Fjord, see three glaciers, and we also almost ran into a black bear while walking downtown (luckily it was more scared of us and ran away!).


Sunday, December 16, 2012


On December 7th we had our SOURCE presentation to share the results and findings of our project. We had a poster created to help illustrate our findings about obesity in the Cleveland Schools and we presented the project and our conclusions with anyone that wanted to hear more about our work this past semester. Overall, I think we presented very well as a group and many people complimented us on the work we completed over the fall semester. I never really had an opportunity to look back and see everything our group had put into our project but sharing the experience with other people really helped me appreciate how much we had actually accomplish. Some of the people we spoke with wanted to see this project continue because they felt it was important. Up until that point i was not overly concerned with the impact our project would have, I was more worried about the final grade. However, hearing those compliments made me feel that our group had actually done something meaningful and that it could help bring about some change.
I think our project turned out very well I would just like to say thanks to Shannon, Jackie, and Dale for all the hard work they put in on the project. Good job team.  

Looking back on my CMSD experience

             Now that the semester is at an end it is nice to take a step back and see all that we, as a group, have accomplished over the past semester. I feel that we have accomplished a lot in the amount of time given to us to achieve our goals.Going out into the community to check the height and weight of children in about 70 schools is no easy task. We had a great deal of help from the sophomores  juniors, MN students and the BSN students from Ursuline college. we would not have been able to accomplish our goals without their help. The teachers and staff were also incredibly kind and accommodating  Everyone we met was helpful and cooperative and seemed to appreciate what we were trying to do within their communities. 
            During the time I spent in all the of the Cleveland schools this past semester I was able to identify a few strengths and positive aspects within the community.  Many of the schools we visited were brand new buildings with modern facilities. Even the buildings that were not brand new were relatively clean and gave the students an adequate atmosphere for learning. Another positive was the attitude of the teachers and staff. Everyone was always incredibly cooperative and did what they could to help us achieve our goals in a timely and efficient manner. A lot of the teachers seemed generally interested in our program as well.  When we were travelling to a few schools collecting feedback about our data brochure many of them wanted to keep the rough draft to share with the rest of the faculty. I guess overall I would say I was surprised by the amount of cooperation and enthusiasm we received from most of the schools. I got the impression that they wanted us there and that what we were doing was important to them.
            After spending time in the schools I believe the role of public health nurse is very important for overall community well-being. The obesity rate in many of the schools is well above the state and national average. Also, many schools in the Cleveland school district do not have school nurses. One of the primary roles all nurses play no matter what setting they are in is educator. These kids probably do not have anyone to teach them how to eat right and take care of themselves. I know money is always what it comes down to but the lack of health education is having a severe negative effect on young kids within the community.
            I think one of the major goals of this project was to learn how to learn how to work well as a team. A lot of effort needed to be put in to get everything ready to go out into the community and check the children’s height and weight. Even more time and effort was needed to analyze all the data we collected during our screenings. Our project would not have been successful if we did not learn to work together . Another goal of this course was to learn to accept more of a leadership role. I think this came into play more during the actual screenings. Sometimes we would be out at the schools as the leaders with no other faculty so we would be the ones calling the shots and everyone would be looking to us to know what they needed to be doing. I think I handled the responsibilities of being a leader and met the goal I set for myself in the beginning of the course.
          In the hospital it might just seem like nurses are there to help fix people that are broken or sick. Now I think it is important that we, as nurses, spend more time working to prevent sickness and disease before it occurs. The data we collected in the Cleveland schools offers valuable insight on a very concerning problem affecting the youth of the Cleveland school district. If it’s not corrected there will be many more sick people in hospitals when these children grow up and reach adulthood.  Waiting until something goes seriously wrong and requires medical attention is not a good way to handle any health issue.    

Now that I have had a few weeks of screenings under my belt, I feel much more comfortable.  Whether I am working in the office on the Ipads or in the field with the children, I believe I am prepared for any situation that may arise.  I can now feel myself pre-planning each visit in my head and seeing potential problems before they appear.  This past week, screenings were being done with the MN students and the flow of the room was beginning to slow down.  I noticed that a few stations were way too close and during a short break I moved the room around slightly and it dramatically helped the flow of students.  I also notice myself assessing each student for hygiene, overall health, and moral.  Instead of the assembly line of weighing and measuring, I see the deeper more intimate side of what we are doing.  There is so much to learn from the brief amount of time we spend with these children.  Cleveland schools still have a ways to go but I have notice great progress from the last few years of my interaction.  I have also notice many things from my colleagues as well.  Mike Koopman is my closest friend from school and many people know him as being very quiet. I, on the other hand, have seen him mature in his performance and even open up with the children.  I hope my maturity has been as apparent as Mike’s.  

The first week back in the schools went extremely well.  My skills returned to me quickly and I felt comfortable doing the screenings again.  There were many positive things I saw and experienced while being back in the schools for the first week. 
One positive thing I experienced was a welcoming feeling from the school staff.  Having the faculty on board allows for a cohesive process and makes the day much smoother.  The principle greeted us in the main office with a smile and warm hospitality.  The next positive thing I saw was the maturity of the junior nursing students.  They came into the building helping us unload the equipment without being asked and set up their stations with ease.  Their ability to handle themselves in such a professional manner really helps the senior’s job in coordinating the screenings.  Another positive thing I saw was the reactions of the students.  The third grade students were excited to see us and seemed like they were having fun with us.  When the students enjoy being with us, the process goes very well without incident.  The next positive observation was the moral of all the senior nursing students.  I was feeling overwhelmed the few days leading up to our first day as leaders but was put at ease by the teamwork we put in to make the day successful.  Being the first day in charge, I was not sure how to handle myself in any tricky situations.  One example being the ipads showing multiple records of students when their ID numbers were input.  The solution was extremely simple but never having dealt with such a problem, I was not sure what to do.  After playing with some settings in the ipad, I found the records were easy to navigate and the right student was located.  The final positive experience I had involved the CWRU faculty. After seeing how efficiently we worked, the faculty commended us for such a great job.  This was great for my confidence as being a senior leader.  I felt very reassured and am now more comfortable in a leadership role among nursing students.        
There were many differences being a senior in the school settings.  Having more authority scared me at first but I was put at ease after directing traffic between the juniors.  I instructed the juniors to set up their stations and paired up the runners to be in charge of bringing the students in for screening.  Being in the atmosphere and not actually screening was extremely different.  I still had interactions with the students but not to the extent I was used to.  Also, the junior nursing students showed respect for my position yet were still comfortable with asking me questions. 
I learned a lot being one of the senior nursing leaders.  There is a lot of effort that goes in to setting up each school and making them aware of our visit.  There was a schedule sent out with all 70 schools and our visits but schools still seem in the dark.  I learned how to ease the process of checking in students, screening them, and returning them to class.  This process is vital to make our visit successful.  Any delays will throw off the schedule and push back times for other schools as well.  Overall I had a great time being back in the schools and am excited for the rest of the semester.

Monday, December 10, 2012

End of Capstone

With capstone being officially over, I have had some time to think about the work we have done throughout the semester. It has definitely been an interesting semester, but I have come to realize that the work we do in the Cleveland schools does make a difference. Mid semester, we made the discovery that an overwhelming amount of kindergarten and third graders fall into the overweight or obese category. At first, it did not really seem like anything we did would make a difference because we were tackling such a big issue. However, I think we all have realized that even just making people aware of the obesity crisis could potentially make a difference.
For our project, we decided to make an informational brochure to distribute to Cleveland's ward with the highest obesity percentage in the children we screened. This being said, we took a draft of our brochure to the three schools located in Ward 11, and received feedback from some of the faculty and staff at these schools. We received a lot of positive feedback, as well as helpful suggestions to improve the brochure. The faculty suggested that we distribute the brochure to the entire community because it is such an important issue and needs to be addressed.
The schools do not really seem to be addressing the obesity crisis that is happening not only in the area, but everywhere. This is only because they simply do not have enough time or money to implement programs that address obesity when there are other, more acute health problems present in the schools. While interviewing school nurses and school principles, it was stated on multiple occasions that asthma, diabetes, seizures, and other more acute health problems seem take importance over overweight and obese children. Although this makes a lot of sense, obesity can lead to other health issues in the future, so I think that a continuation of an obesity project would be a great idea for a capstone group in the Cleveland schools next year. Possibly a continuation of the research we have already done. We have identified several possible correlates relating to the amount of overweight and obese children in the Cleveland area, and it would be interesting to see what a group of seniors next year could do with this information.

Wednesday, December 5, 2012

The End

As this semester comes to a close, I’m realizing I’ve learned a lot more than I originally thought I would. Even though we have years of experience at the Cleveland public schools, working at the Lorain County General Health District introduced me to other responsibilities of the public health nurse. Public health nurses educate, prevent, protect, and advocate not only for individuals but an entire community. I have had the opportunity to participate in Bureau for Children with Medical Handicaps visits, Children Service visits, Adult Health Clinic appointments, newborn visits, and immunization clinics. At first I was very uncomfortable with the idea of walking into someone’s home and being the health “expert.” I kept thinking if I say something wrong they are going to throw me out and I’ll be stranded. I can be quite dramatic. However, every family and member of Lorain County that I came in contact with was very receptive to us and wanted to better their health.
In addition, the Lorain County General Health District offers many other services through their Health Education Department and Environmental Services Department. I am impressed by the amount of services the health department offers in comparison to the amount of members they have on staff. Their small staff does so much for the community.
I learned a lot from working with an agency and working with a partner as well. I have learned the art of negotiation and how to conduct myself in a professional setting. Teamwork is key to being productive and you don’t always have to be in control. In regards to research, sometimes it doesn’t work out and that’s okay, try again!
Overall, my whole perspective of public health nursing has changed. I have more respect for what they do and realize it is a complex, difficult field. There are many things that affect the care they can give, such as funding, governmental policies, amount of resources, culture, and receptiveness of the community.  I enjoyed my experience at the Lorain County General Health District. The staff has been eager to teach us and went the extra mile to get to know us as people too. I plan to keep in contact with many of the staff members in the future. I would like to thank them all and the agency for this semester. I hope that we have done a project that is beneficial to them and they have enjoyed having us as well!

Monday, December 3, 2012

So loooong CCBH cubicle!

I learned a lot at CCBH. I really enjoyed the people there, and everyone was very attentive to us students. What I learned most about myself at CCBH was that I hate sitting in one place for an entire work day. The cubicle I was assigned to was not for me. I twiddled my thumbs, I did laps around the cubicle farm, I drank extra water so I had to use the restroom more often, you name it- I probably considered it or actually attempted it.

I loved working in the family planning clinic, going on home visits, visiting different colleges and so forth. If it got me out of my cage, I was willing to try it at least once. I loved working with the older nurses who had worked in hospitals for years prior to the board of health; who could tell me a number of different stories about different things they've seen and where they've worked. I liked meeting new people and CCBH helped me do just that... once I could spread my wings and enjoy the outdoors again.

All in all, I really enjoyed my time spent at the board of health. I'll definitely miss the people I worked with there. I'll especially miss my preceptor and the family planning clinic. The clinic was always so interesting with different types of people every day. I'll miss the diversity, but hopefully as I enter my preceptorship and graduate I'll encounter much more diversity down the road that will be just as good-- if not better. I'm excited to start the next chapter in my nursing career and my life. See ya CCBH, so long cubicle... and HELLO preceptorship!


At the Cuyahoga County Board of Health, we work in the family planning clinic at least once a week. This particular week, instead of participating at the board of health, we went to John Carroll University and performed STI and pregnancy tests for any students who requested it. This service was a free walk-in basis in the school's health services office.

Working with the health department was different for this type of endeavor. First, we were working with the same age range as we were, so approximately ages 18-22. To top it off, we knew that majority of the students that came into the office were educated, as JCU is a very well accredited school. I must say, this was much different than working with adolescents or young adults in the family planning clinic at CCBH. The people who come into CCBH know Case is a great school, but to a lot of JCU kids, I felt they just thought of us as students from the school down the street-- or rather that's what I feared they would think about us. Turns out, they didn't. Most of the students were happy to have a person his or her own age in the vicinity. I think we helped alleviate the stress of them going into a scary, and potentially life changing, situation.

After helping out at the health screens at JCU, I felt much more comfortable in my role in the family planning clinic. It was a nice change of pace and a very nice boost of confidence in myself and in my education.

Capstone coming to an end

             As we have come to the end of our capstone experience, I have realized Iam excited to move onto preceptorship; but will miss going to the site of Southwest General, for the staff we were lucky enough to meet were so wonderful. It has been very interesting to see what has become of our final project, and everything has come together very smoothly. Creating the poster was without a doubt tedious, but I have learned so much from the process.
            Looking back on all of the experiences I had at Southwest, I am more than grateful for our placement. Even though we had a late start, I rather have had that late start at Southwest than have been at another site. We were able to see such a wide variety of public health situations, ranging from home visits, to community screenings, and even to outpatient hospice. The specific project we developed was enlightening and I hope that the data we have gathered and analyzed, and conclusions we have come to, make a positive impact for the transition nursing program. Hopefully what we have started will provide other capstone groups with information to build off of during capstone projects next year. Listening to everyone else's presentations this morning and afternoon was very exciting.  Furthermore, finally getting to present what we have been doing to our professors and classmates all semester was very fulfilling, thank you!

End of Capstone

Now that capstone is complete, I've had a chance to reflect at this semester.  Throughout the last 10 weeks, my perception of public health has changed.  First, there are many more aspects to public health other than nursing than I originally thought.  The environmental services department and health education department play pivotal  roles in promoting wellness and preventing the spread of disease.  Health education brings the tools and resources to staff and clients alike.  I got to see how the environmental services department prevents the spread of disease through mosquito control.  In addition to that, they help maintain other aspects of our daily lives that often goes without thought, such as food safety at restaurants.

The nursing department is involved in many programs that I have and have not heard about.  Programs including WIC, BCMH, Children Services, Adult Health Clinic and newborn visits are all things that I was able to participate with during my tenure in Lorain.  Prior to this experience I never fully appreciated the scope of nursing practice in the public health setting and how much they monitor in the community.

Overall the capstone experience was good and I look forward to the next stage in the process of becoming an RN.

Our Ohio Family Planning Insurance Marketing Campaign

Development of my group’s actual Problem Solving for Better Health (PSBH) project was perhaps one of the most challenging, insightful, and rewarding learning experiences of the semester. Prior to Capstone, I’ve had plenty of PSBH experiences but this Capstone project definitely tested and enforced the valuable concepts of the PSBH model that I have learned in previous coursework. Our first step was planning and assessing our community: Brooklyn, Ohio. During this time, I learned a lot about the health problems inflicting the communities as well as strengths and weaknesses present within the community. This portion of the project taught me important lessons about community partnerships and finding community resources in order to better solve community health problems. We met with CCBH staff and staff at the Old Brooklyn Family Service Center for guidance developing our project. After meeting, I was excited that we agreed to implement a marketing campaign for recent Ohio Medicaid family planning expansions. During my experience in the Title X clinic, I found that this was such an important community need. It is a critical program that many community residents are not aware of. By attempting to raise awareness for Ohio Medicaid, I realized that I would be playing an instrumental role in helping disadvantaged individuals gain health care access to critical family planning health services. It was great to witness how such a small project could have such a large potential impact on the community. I found research that supports that this program can provide more people with health access and thus contribute to a reduction in unintended pregnancies and STI rates.
            Our marketing campaign went well. We visited many, at least 300, different locations businesses in Brooklyn. We spoke with many Brooklyn residents and patients in the clinic. Alone we directly referred more than 2 dozen patients to Medicaid. This does not seem like a lot; however, like Medicaid family planning expansions, the Title X clinic is new. Thus, it has not established that large of a clientele when compared to other clinics. Additionally, we also went to local colleges near the community. Overall, I feel our marketing campaign was a success and made a valuable impact in the community.

My experience in a Title X Family Planning Clinic

This Capstone has been an excellent learning experience. I was stationed at the Cuyahoga County Board of Health (CCBH). Specifically, my partners and I were mainly focused on the Title X family planning clinic at CCBH. Over the course of the semester, I learned so much about various health topics including Medicaid, family planning, the Title X program, and other health and socioeconomic issues relating to reproductive health and wellness. I learned about my targeted community and how to implement an actual problem solving for better health project. Before my first day at CCBH, I knew that I would be working primarily in a STD testing clinic. However, I was not expecting this experience and was not expecting to have the opportunity to work in one of the Ohio family planning clinic with Title X funding.
            Title X clinics, such as the one at CCBH, play a significant role in ensuring access to a broad range of family planning and related preventative health services for millions of low-income and uninsured individuals as well as others. These clinics have a different set of guidelines, protocols, and initiatives. For example, during the patient interviewing process CCBH staff are required to ask questions about general health topics in addition to sexual health ones. I did not expect this initially but it was not uncommon to find staff providing education on smoking cessation for a patient visiting the clinic to for a routine HIV screening. It was interesting becoming familiar with the various functions and responsibilities at a Title X clinic.
            Furthermore, the clinic serves a wide variety of patients. The patient population at the clinic was very interesting. According to the clinic’s priorities, I saw many low-income and uninsured individuals as well as those able to afford family planning services. I learned about the health care delivery system in terms of family planning services and how health disparities such as lack of insurance coverage can have major consequences for entire groups of people within a community. During my time at the clinic, I had a lot of opportunities to provide patient education. Each time, imparting critical knowledge to these patients became easier and easier for me. Finally, I learned about more extensive details and nursing implications for sexually transmitted infections, contraception, and general reproductive health issues.

wrapping up our work in Michael R. White

On November 15th we implemented our last intervention within the school. This intervention involved hosting a healthy cooking demonstration within the school. Our final intervention for this project was designed to engage the parents in helping their children make healthy food choices. Early childhood obesity, like other health disparities, disproportionately affects low-income populations. The Michael R. White community is not
exempt from this. A study conducted in October 2012 confirmed the link between family influence and obesity. The study examined maternal age, income, education level and BMI. The most significant finding of this study was that healthy weight mothers were more likely to have healthy weight children than overweight mothers. The findings of this study reinforce the importance of addressing the influence of maternal socio-demographic factors on child weight, in particular, maternal weight.

Keeping this knowledge in mind, we decided to target the parents of the students. We partnered with Bon Appetite for this event. Over 20 parents attended our cooking demonstration, in which we taught how to make a simple stir fry using vegetables and whole grain rice. The parents were really receptive of our education. Along with the demonstration, parents were given a healthy cooking cookbook, that featured recipes which were simple, economical and kid-friendly.

Attached is the video which was made on our project.

Sunday, December 2, 2012

Understanding Research in Practice

       Wow!  It's hard to believe that my capstone is done.  What wonderful experience it was.  One of the greatest things I learned during this experience is how research really effects change in clinical practice which in turn leads to better patient care.  When you take a seminar course about research, you appreaciate all the work that goes into it and the importance it plays in the greater nursing profession.  What was lost on me and many other students, is how research can greatly impact the care of patients.  It doesn't have to be big or ground breaking to positively impact a patient.  Most of our capstone projects were not ground break, all though I'm sure some where, but almost uniformly they helped improve the lives of patients and staff members where they were conducted.  This is something I will carry into my future nursing experience.  Wherever and whatever type of nursing I practice, I will strive to incorporate evidence based nursing and advocating for my fellow nurses.