CMSD & Michael R. White

     Working in the Cleveland Metropolitan School District elementary schools and at Michael R. White STEM school has been a lot of fun so far this semester! As many of you know from our community clinicals, the CMSD kids are generally really excited about having FPB nursing students in school with them and want to talk to us about a lot of things, ask us questions, and tell us about their lives. The teachers are also pretty glad to have us there because they know we are trying to increase the students’ health through various measures.

     The drive to Michael R. White is a nice drive down Wade Park and East Boulevard. There is a lot of trees and general green space and you pass the Cultural Gardens on your left. The houses vary somewhat in terms of the conditions of their upkeep but in general it is a pretty and pleasant drive and the neighborhood feels safe. Michael R. White itself is a nice brick building with a playground out front where lots of kids are running around and playing, depending on what time we arrive there. The inside is not brand new but it is clean and well-maintained and has a nice homey feeling, as schools go. When we go there we usually meet and work in the parent resource room, which currently has fall-themed decorations on the tables.

     The project for the three of us (me, Kayla, and Thea) is the continuation of what some seniors started as their capstone last year and what some of our class did as juniors in the spring—taking Michael R. White 5^th and 6^th grade students to the Case farm and teaching them lessons about farming, ecosystems, soil, nutrition, etc. We do this with the hope that seeing a real live farm will get them excited about their science curriculum and make them more mindful of their food choices, because they will have seen a place where food originates and had lessons and hands-on activities there. We took a trip to the farm (which is gorgeous!) to discuss field trip dates and lesson plans with two of the farm employees, who were very accommodating and enthusiastic about doing trips with the Michael R. White 5^th and 6^th graders. This week we have been having meetings with different faculty at the school to confirm our lesson plans and find out more about the students and the community.

     We have also been spending a lot of time going into many different CMSD schools to help conduct eye screenings in preparation for the OneSight clinic vision bus. We have been screenings kids of all ages but the kids ages 8 and up are eligible for free glasses if their vision is bad enough. That has been an incredibly eye-opening experience because in a short time we have gotten to see a huge range of student population types and schools within CMSD. It is also very interesting to see how many of the kids desperately need glasses but haven’t had them before, and it feels great to know that they are going to get a pair for free that will help them see and achieve more in school and in life. 

Cleveland Department of Public Health

Now one month into my Capstone experience at the Cleveland Department of Public Health, I am finding my niche in the public health culture. Though CDPH runs administratively out of a downtown Cleveland office, the ground work takes place primarily at two reproductive health clinics, one on each side of town. As I quickly found out, though, the clinics do far more than just treat for sexually transmitted infections and prescribe contraception. Working in these clinics, I have administered and read TB Mantoux tests, delivered pregnancy test results, given out more flu shots than I can count, and even immunized children. Though the signs on the door may say one thing, the nurses of CDPH wear many more hats than that of a nurse in a clinic. Especially now that flu season is getting into full swing, we drive all over the city of Cleveland setting up shop with flu vaccinations, both for those with insurance and without.

Working with CDPH has opened up many experiences for me. I have never worked in a clinic before, so it has been a very different setup bringing the patient back to treat them in "my space" versus treating a patient in the hospital, where the care is brought to them. The pace is also much different; each employee - from the clerk, the lab technician, the triage medical assistant, the nurse practitioner, and the discharge nurse - has their own role with their own set of tasks to complete. Each of us only works with one patient at a time, as compared to the average floor nurse who runs around between multiple different patients throughout a shift.

Even though I have only been at the reproductive health clinics for a few weeks, I find the work I do to be very fulfilling. The patients we are working with are in a very vulnerable state, and the treatment and counseling we give them is very personal information. We not only explain their diagnoses and medications, but also help them to cope with what their diagnosis means for them socially. Just a few powerful words to a patient can give them peace of mind or destroy their relationship with a significant other. I have shaken hands with grateful and smiling patients, and comforted those who are angry and distraught. I am helping people in their times of need, irregardless of their ability to pay for their services. I very much enjoy the feeling of giving back, and I look forward to even more time in the clinics in the coming weeks ahead.

New Experiences in Wuhan, China

Sophie and I have been going to the traditional Chinese clinic with a group of Hope School of Nursing students here in Wuhan. At the clinic, we have observed traditional Chinese medicine which includes cupping, acupuncture, and massage therapy. We even got an opportunity to practice cupping on a fellow student. Some of the students even tried to perform acupuncture on themselves! The nurses and students are welcoming and open to us observing these traditional practices. Also, the patients were eager to learn about Sophie and I. Coming from a home where Chinese is commonly spoken to me, I was able to understand and semi-respond with head nods and smiles to their questions about us. We even got the opportunity to accompany two nursing students on a home health visit where they educated a senior citizen about preventing constipation.  Also, we attended a constipation education seminar at the local community center where at least thirty geriatric community members were in attendance. At the end of the seminar, they played a jeopardy game to gauge what they learned and were rewarded toothbrushes, washcloths, and bananas. They were beyond excited to be receiving these prizes.

On a typical morning to the clinic, we start with an hour public bus ride, which involves changing buses. We frantically run to the buses and hope there are open seats, or we stand shoulder to shoulder among Chinese businessmen and women. While driving on the bumpy roads through Wuhan, we pass by skyscrapers, giant shopping malls, rural villages, and even a Starbucks. Once arriving, we grab freshly made breakfast (Chinese-styled eggs and rice or noodles) from side carts often in alley ways. We grab our food in paper bowls and wooden chopsticks and walk to our site.

After 5 weeks in Wuhan, I have grown accustomed to the lifestyle and culture and even found my Chinese to be improving.  I have gained many hands-on experiences in the traditional Chinese clinic and have made many new nursing friends who enjoy showing us Wuhan’s sites. I am enjoying challenging myself every day in this different environment and hope to gain more valuable experiences in my remaining weeks.  

Otis Moss Jr. Medical Center

I didn't really know what to expect on my first day at Otis Moss Jr. Medical Center.  I was assigned to the pediatrics floor the first day, and was thrown right back in to a sea of immunization schedules and different assessment techniques that I had only previously used in my pediatrics rotation last spring.  The nurse I was working with quickly brought me up to speed on how the staff checked patients in, and explained the call-back process for kids with abnormal blood work.
At Otis Moss, blood work is drawn on all kids starting at age two.  Generally they are checked for iron and lead levels, cholesterol, and Vitamin D. When I first learned that this was protocol at the facility, I was surprised, because I can seldom recall having lab work performed on me as a child.  I soon learned that this was a necessary task, although frightening to most of the patients.
I realized that this was necessary because of the number of kids with high cholesterol levels.  Some of them were as young as eight years old, and had cholesterol levels that were as high as 190 mg/dL, which is far above the 'high' level of 170 mg/.  As I looked back to past years in their charts, it became apparent that this was a problem that started at an early age.  Throughout my first week, there were many parents who came in explaining that their family had switched to skim milk instead of whole in order to bring down one of their children's cholesterol levels.  This seemed like such a novel idea to the parents, but appeared to do wonders for their children's lab values and weight.  At every visit, a child's BMI is assessed, and it was exciting to see parents and children alike have their efforts of diet change pay off as their blood cholesterol levels decreased alongside their weight.
It is impressive how these test results can spark a change for an entire family.  I know that many of these families have more changes to make, but it is exciting to watch them reap the rewards of their efforts.  I am interested in seeing how the health of older adults is being impacted on the adult unit as well.
-Taylor Daiello

Virgin Islands

I have been in the Virgin Islands since August 12th and so much has happened since then. When I first got off the plane and walked into the airport there was a booth of free rum shots. Maddie and I each had a rum shot and I thought to myself I am definitely not in the states anymore!  Since that day off the airplane, I have become more accustomed to the culture here on the island. The culture on the island is different from the lifestyle of the states. A common phrase here is "we are on island time now." There is no rush to get things done. It was an adjustment and I am still working on taking things slow. Besides the culture being more slowly paced, there are many other things that I have learned. One of the things that I first observed is that coffins are placed on top of one another. I was very confused about this custom until I found out someone is buried under the ground. The coffins on top are relatives of the person buried under the ground. Customs like these are just some of the simple everyday life things that I am learning.

Since being on the island I have been to many different beaches. I have never been on an island before or gone snorkeling. Now I have been to two islands and I am taking a snorkeling class.  All the beaches are beautiful and have their own unique qualities.  The Virgin Islands is made up of three islands and after a time you can tell who comes from what island.  Each island has their own characteristics along with the accents of the people.  Having friends from the different islands helps me learn and understand their culture better.  When I am in the car with my friend J’Nique,(driving on the left side of the road) we listen to her Caribbean music, which I can barely understand.  J’Nique has to translate the meaning of the song to me as she gives me more details about the culture of St. Thomas. 

J’Nique and I teach various lessons to women who have suffered from domestic violence.  The women are staying at the only shelter on the island that is for women only.  The women are at a very trying and vulnerable time in their life so it is important how I go about my teaching.  I quickly found out that the women love to share and my first two lessons went very well. We discussed healthy relationships, values, and the importance of communication in a relationship.  I also make a home visit once a week to a patient who is on hospice care.  I have learned a lot about the importance of family dynamics and the culture of caring for someone on hospice. 

I am looking forward to continuing care for both my sets of patients.  I am also looking forward to continuing my understanding of the Virgin Islands and experiencing new beaches.

Mat-Su Public Health Center, Alaska

Time sure does fly when you are having fun. I have been in Wasilla Alaska for almost seven weeks now. Before leaving, I was very unsure of what to expect. I was told this was going to be a once in a lifetime experience and so far it has. Between zip lining through Denali, admiring the dozens of glaciers, hiking the mountains, and exploring the wildlife, Alaska isn’t like any other state I have visited before. Businesses, houses, stores, etc are very sporadic. Healthcare centers are located in the central areas like Anchorage, Fairbanks, Bethel, and Wasilla. Those who live outside of these major areas have difficulties getting access to healthcare due to the lack of transportation. Therefore many are without health care. Coming from living in an urban setting, it makes you appreciate having nearby resources.

The Mat-Su Public Health Center provides several child health and reproductive health services. The clinic is based on a sliding fee scale. No client would be denied care due to the inability to pay. The Public Health nurses focus on immunizing children and providing screening for STDs and birth control methods to the at risk population. So far, I have had the opportunity to participate in several activities. I have done newborn screenings at home visits, presented about immunizations at a local college, went to the Women’s shelter twice for small group talk, administered lead screenings at an Early Learning program, and attended several community meetings. I have learned that education is a key role in Public Health nursing. I found the majority of the population doesn’t see the importance of immunization and reproductive health due to the lack of education. For my project, I have chosen to educate teenagers (15-19) on sexually transmitted diseases and healthy relationships.

I am really looking forward to going to Bethel at the end of this month. I am extremely excited and nervous at the same time. This is a very high risk population. I have been told that this environment is comparable to a third world country. There are issues with housing, potable water, access to healthcare, etc. Spending a week with this population is going to create an even greater appreciation for what’s taken for granted daily. With several weeks still left in Alaska, I can guarantee I will gain an even greater understanding of the importance of Public Health nursing.

Virgin Island Experience

            I can’t believe I have been in the Virgin Islands for nine weeks already. I have countless experiences that I will remember for a lifetime. Katie and I have taken a dinghy around St. John, eaten fungi, picked up a foot long starfish and so much more.  However, completing my capstone in the Virgin Islands is not just a fourteen week long vacation. I’ve had a little bit of a culture shock – and we are still in U.S. territory! “Island time” truly exists. Everything takes an extra few minutes to get done. The dining hall is not an all-you-can-eat buffet like Leutner. Instead, a student is only allowed to get food one time, and since meat is very valuable on the island, only one choice of meat.  The McFlurry’s are just ice cream with oreos on top. And the place to shop is Kmart.

Additionally, my public health experience is very different from the rest of the senior class. I have spent my last six clinicals doing home visits to the same Hospice patient. Every Thursday morning I get on a safari, which is similar to a bus with no sides. Nursing bag in hand, I trek up a giant hill for about 20 minutes then up 48 stairs to my patient’s house. I am always out of breath when I arrive! However, these home visits have been such a beneficial learning experience. I have been able to establish a rapport with my patient and her family by visiting them weekly. I have learned how to incorporate the family as a whole into my care and teachings instead of just focusing on the patient. Home visits are so important because it allows patients to receive care, in a secure and safe place, surrounded by people they love.  I am honored that the family agrees to have me in their home.

This Thursday I am starting my teachings at the Family Planning Clinic. Since domestic violence is such a prevalence issue in the Virgin Islands, most of my lessons are focusing on identifying abuse, healthy relationships and self-esteem. I look forward to teaching women about these important issues as well as learning more about the culture myself.