For three days I have been assigned to do my capstone hours for nursing in the South Central Foundation Clinic. Each day I was assigned a different nurse manager as a preceptor. I would like to share a little about what I learned each day.
Day One in the Clinic:
Today I was with Jazz. She was a spunky young woman, very passionate about her job. I learned a lot about how the clinic works. Patients are referred to as customer-owners. The customer-owners can schedule an appointment for anything they would like (physiological or psychological). When an appointment is scheduled, the nurse manager then goes through their chart to determine if the customer-owner is due for any other screenings or assessments. I was impressed with this method and brought up to Jazz, wondering why this wasn't done everywhere. She explained that if we all tried to clump all our cares in one visit, many of us would be unable to afford our clinic visit. It is disappointing to know that the preventative care that is clumped at this clinic is often not done in other regions because people cannot afford it! I was surprised at how fast most the day went. Jazz was such a friendly and energetic person and she taught me a ton!
Jazz sent me on my way with the following learning points:
Day Two in the Clinic:
Today I was with Velia. Velia spent a lot of time emphasizing continuation of education and taught me a lot about the commissioned corps/United States Public Health Services, which Jazz was also a part of. We talked a lot and spent a bunch of time responding to messages about customer-owners.
Below I have put bullets of the take away points I have had today:
Day Three in the Clinic:
Today I was with Marlyn, also a member of the USPHS. Today was the clinic's quarterly training day and so from 1100 to 1300 we went to the quarterly education event which included three presenters and free lunch! I will highlight some of the things each presenter said that stuck out to me.
Today it was sad to leave the clinic and know it may be the last time I'd see many of those faces again, however I did leave with a desire to come back and could see myself back there one day.
Today I was with Jazz. She was a spunky young woman, very passionate about her job. I learned a lot about how the clinic works. Patients are referred to as customer-owners. The customer-owners can schedule an appointment for anything they would like (physiological or psychological). When an appointment is scheduled, the nurse manager then goes through their chart to determine if the customer-owner is due for any other screenings or assessments. I was impressed with this method and brought up to Jazz, wondering why this wasn't done everywhere. She explained that if we all tried to clump all our cares in one visit, many of us would be unable to afford our clinic visit. It is disappointing to know that the preventative care that is clumped at this clinic is often not done in other regions because people cannot afford it! I was surprised at how fast most the day went. Jazz was such a friendly and energetic person and she taught me a ton!
Jazz sent me on my way with the following learning points:
- Patient (customer-owner) education:
- Always assess the customer-owner's readiness to learn, even over the phone.
- Provide easy to read handouts with pictures and easy to follow charts.
- Create a professional portfolio and keep adding stuff to it as you attend workshops and other educational events.
- Take the time to learn why a customer-owner is non-compliant to a treatment regimen or an appointment time.
- Alaska Native time system
- When making appointments or explaining when to take a medication, do not use dates or times, rather use seasons (whale season, berry season, fishing season, etc.) and time of day including activities familiar to the customer-owner ("When you wake up in the morning, take your pill with your coffee.").
- Know your online sources, you will need to look up sources more than you'd expect.
Day Two in the Clinic:
Today I was with Velia. Velia spent a lot of time emphasizing continuation of education and taught me a lot about the commissioned corps/United States Public Health Services, which Jazz was also a part of. We talked a lot and spent a bunch of time responding to messages about customer-owners.
Below I have put bullets of the take away points I have had today:
- Commissioned corps of the US Public Health Service
- Many of the professionals at the clinic are members of the USPHS, including all three of my preceptors.
- Please visit https://www.usphs.gov/ for information on their webpage.
- The members of this organization go where they are needed, caring for undeserved populations, such as the Native populations.
- When there is a natural disaster, like a hurricane, these individuals will get deployed to the area, at different times, and stay there for two weeks to help, but will then switch out after the two weeks to avoid burnout.
- They are overseen by the surgeon general.
- They are offered loan forgiveness and loan repayment, each location they go to is a two year commitment, most people who get stationed in Alaska actually choose to stay after their two year commitment.
- The clinic is very team oriented.
- Each floor has a dietitian, a behavior health specialist, a pharmacist and multiple teams that consist of a doctor/PA/NP, a nurse manager, a CMS, and a CMA. They all sit together in an office and utilize the close space to communicate about customer-owners.
- Continuing education
- At this clinic there is a huge emphasis at continuing education.
- Verification of diagnosis
- There were a lot of verification of diagnosis forms filled out. These were filled out as a way to prove a customer-owner's need for a service that would be covered by insurance, mainly medicaid.
- Consistency in appointments
- Many customer-owners will miss appointments, cancel appointments, or never reschedule appointments.
- Cholecalciferol or Vitamin D3
- Many customer-owners are prescribed to Vitamin D3 due to the lack of sunlight.
- Cancer in the Alaska Native population
- Cancer rates are so high in the Alaska Native population that at the clinic they start colonoscopies at the age of 40 rather than 50.
Day Three in the Clinic:
Today I was with Marlyn, also a member of the USPHS. Today was the clinic's quarterly training day and so from 1100 to 1300 we went to the quarterly education event which included three presenters and free lunch! I will highlight some of the things each presenter said that stuck out to me.
- Speaker one: Matthew Hirschfeld spoke on CSID and Arctic Variant of CPT1A
- The CPT1A dificiancy is a rare mutation that affects a person's ability to burn glucose for energy, often times burning small amounts a fat throughout the day. This however is not a rare finding in many areas of Alaska and other Arctic regions which is why it is called the Arctic Variance. The speaker presented on his data findings surrounding this mutation in Alaskan Native children, linking an increase in infant mortality to this mutation. When infants and elderly have this mutation and get sick, their bodies do not have enough reserves and the mutation can threaten their lives. This mutation is however not linked to SIDS. It is believed that there may be a correlation with the Alaskan Native diet and the gene mutation (no carbs and high in fats).
- The speaker also spent some time talking about another rare disease that children have in high rates in Alaska: CSID (Congenital Sucrase-Isomaltase Deficiency). This disease causes the person to be unable to break down sucrose, which causes diarrhea. This disease stays with the person for life and often shows up as the child gets old enough to eat sweets. The speaker said the best treatment for a child in Alaska is to encourage a traditional Alaskan diet.
- Speaker two: John Bardsley spoke on animals in healthcare
- He differentiated between the following:
- Pets-self explanatory
- Service animals
- Animals specifically trained to perform a task for a disability.
- The only animals that can be service animals are dogs or mini horses.
- This is covered under federal law.
- By law people cannot ask what the service animal is for.
- Animals specifically trained to perform a task for a disability.
- Emotional support animals
- Provide comfort and support
- Can be any animal and does not need special training but can have special training
- Protected under the fair housing act, therefore a person cannot be denied housing a required to pay a pet deposit for having an emotional support animal.
- Housing providers can ask for documentation
- Therapy animal
- A trained animal
- Not covered under federal law but rather by hospital policy
- Pets-self explanatory
- He differentiated between the following:
- Speaker three: Sarah Doaty spoke about inflammatory arthritis
- Those with low economic status are more likely to have more disease processes and decreased mobility.
- Arthritis is one of the leading causes of disabilities in the United States
- There are over 100 types of arthritis
- Arthrocentesis known as tapping a joint
- Those with psoriatic arthritis are at high risk for cardiovascular disease
Today it was sad to leave the clinic and know it may be the last time I'd see many of those faces again, however I did leave with a desire to come back and could see myself back there one day.