Jennifer Needham and her seven fellow students from the Goldfarb School of Nursing at Barnes-Jewish College accelerated nursing program had no idea what to expect as the first Goldfarb group to do their six-week community practicum at Christian Hospital, which ended in February 2015.
“It was the first time any of us had been to Christian Hospital,” says Needham. They found a welcoming staff at the sprawling facility, but they were surprised by what they learned.
The students learned about providing care outside of the hospital walls and how that, ultimately, will help them make the greatest difference in improving the health of their community. It’s that they’ll remember most, says Needham.
“I’ve learned and experienced so much in my time here,” she says.
Needham and the other Goldfarb students — Sarah Collins, Natalie Dallman, Kathleen Lee, Joel Pitcavage, Scott Steckle, Nneka Warren and Raegan Woodruff — rotated over six weeks through CH radiation oncology, adult and senior outpatient mental health, the wound and hyperbarics center, the emergency department fast track, pre-op outpatient surgery, CH emergency medical services’ Community Health Access Program (CHAP), the pain management center, and outpatient infusion.
The Goldfarb accelerated nursing degree program is for students who already have earned a degree in a major other than nursing. It comprises three intense semesters covering all of the nursing content. In addition to their rotations at CH, students will spend the remainder of this term getting pediatric experience at St. Louis Children’s Hospital. They spent the previous terms at Barnes-Jewish Hospital in adult health and at Progress West Hospital focusing on women’s health. The cohort started in May 2015 and the students will graduate in April 2016.
“These students have already had a career, so this is a career shift, and each student comes with different life experiences,” says Patty Eppel, RN, MSN, CCRN-K, patient care manager in the CH Center for Training and Development. “What I really want each student to know is that taking care of people is not just in the hospital — it incorporates a whole continuum of care. Half of my 33-year nursing career is in home health and hospice, so I’m always thinking about what will happen when the patient goes home.
“The Goldfarb students need to understand the challenges of taking care of someone in the community,” says Eppel. “As the coordinator of nursing students at Christian Hospital, I wanted to give the students a real feel for the challenges of providing care outside the inpatient hospital walls.”
Maintaining the health of the community
Community health nursing is a core course in the undergraduate nursing degree program at Goldfarb, says Kay Mueggenburg, PhD, CHPN, RN, Goldfarb associate professor. “It’s important that nurses see and understand that the majority of health care happens outside of the acute care, inpatient setting. The outpatient clinics at Christian Hospital offered a great opportunity for these soon-to-be graduate students to witness nurses as part of the multi-disciplinary teams who deliver care to restore and maintain the health of the residents in this local community.”
Before starting the rotation at CH, the students became familiar with the 2013 community health needs assessment compiled by the St. Louis County Department of Health, focusing on the service areas for CH, BJH and SSM Health DePaul Hospital.
“This helped us understand the priorities in this community, and we saw it play out during our rotations here,” says Mueggenburg.
For example, Mueggenburg notes, the assessment identified a need for mental health services, and the Goldfarb students were able to rotate through two mental health sections at CH — the adult outpatient program and the Center for Senior Renewal.
“The students experienced all outpatient services, which is key to meeting community health objectives,” Mueggenburg says. “And it’s great that all of the staff with whom the students interacted work with patients and families who live in the local communities.”
The students also spent time learning about the CH EMS CHAP, an integrated effort focusing on getting patients the right care in the most appropriate manner — in many cases, preventing a trip to the emergency department. For example, under the effort, an advanced paramedic, in a separate vehicle, responds to emergency calls along with an ambulance. If the paramedic determines the case isn’t truly an emergency, the paramedic releases the ambulance and its crew back into service, and provides the appropriate care at the patient’s home.
CHAP also seeks to improve access to primary care in the community. The program has touched more than 7,500 lives since its introduction in February 2014.
“I think having the students experience CHAP was key,” says Eppel. “They rode with the paramedics and were able to go into patients’ homes to see, firsthand, the challenges the patients are facing just trying to take care of their health care needs. That’s why I think it’s so important to give each nursing student the opportunity to look beyond the hospital walls and know that there is care beyond this building.”
“I didn’t realize the extent that the EMS team at Christian has gone to with CHAP,” says Needham, who has a bachelor’s degree in health studies with an emphasis in community health from Central Missouri State University.
Terry Stafford, CH Pain Management Center manager, says the rotation in her area was the students’ first exposure to pain management. “We help patients whose lives were deteriorating get their normal life back,” says Stafford. “That’s what we do. We work to get patients as pain-free as possible so they can have their normal life back. It was eye-opening for the students.”
“It’s been helpful to follow not only nurses while at Christian, but also social workers, radiologists, other physicians and many other health care professionals,” says Needham. “Everyone has let me get in behind the scenes and explained to me exactly what it is we’re doing. It’s been a great experience working with all the staff.”
Helping people enjoy life by improving their health
Eppel reiterates the need for a 360-degree vision when it comes to nursing.
“Each student needs to understand that care doesn’t stop at the hospital doors,” she says.
“We demonstrated our mission to these students — to help people enjoy life by improving their health. That is exactly what our outpatient facilities do. They help people heal so they can get back to a normal life, whatever that normal is for them,” Eppel says. “I’m so proud of the departments here at Christian Hospital for opening up their doors and arms to allow the students to have this experience. The Goldfarb students are going to be better nurses because of it. I have a feeling they will always remember the experience each had here at Christian Hospital.”