"Tomorrow's 'whole person' cannot be whole without an educated awareness of society and culture with which to contribute socially, generously, in the real world" (Kolvenbach, 2000)

After completing 16 hours of service learning at the Saint Vincent de Paul free medical clinic and reflecting on the words of Peter-Hans Kovenbach (2000) concerning service learning education in a Jesuit Education, I must agree that, without experiential learning, an education on social justice and societal contributions cannot be fully appreciated in the learning domains of empathy, observation, and reflection. Using experiences to open one’s senses—sight, smell, and hearing—allows a learner to experience the grittiness of reality to understand poverty, suffering, despair, and hopelessness that we all know as empathy and compassion. Through reflection, one can critically think and act accordingly to assist, motivate, advocate, and collaborate with others in decreasing the suffering while increasing the advantages of the vulnerable populations. The DNP service learning experience enhances my learning through experiences which affect the population health, inter-professional collaboration, ethical decision-making, political advocacy, health care policy making, leadership, and systems thinking (Chism, 2013). The roles will help ameliorate suffering and create empathy for the underserved, vulnerable, and disadvantaged populations within my community.

Description:

74 y/o Greek woman presents to the St Vincent de Paul Free Medical Clinic (SVDPFMC) with an infected right index finger. The tip of her index is inflamed, swollen, erythematous, and has a purulent white discharge when expressed. Her vital signs are as follows:  BP 148/80 mmHg; HR 130 b/m (regular); R 22 (regular); T 102.8 ° F. Additionally, her FSBG is 350 mg/dL, BMI 30, and has a history NIDDM. She is homeless and has been diagnosed with schizophrenia with bipolar features. 

Examination:

A vulnerable older woman, who has an untreated psychiatric condition, now has a life-threaten infection in my community that needs my intervention in order to survive. Without treatment, this individual will eventually develop severe sepsis and diabetic ketoacidosis (DKA) requiring amputation of her finger and prolonged hospitalization. Synthesizing observation and evaluation of evidence based clinical practice is paramount in this environment. Advocacy for the underserved and vulnerable population is the key in developing trust and understanding in the community that SVDEFMC serves. Accessing community health programs through networking allowed me to assist the patient to be admitted in a nearby county hospital with specialists to manage the patient appropriately (surgical, medical, and psychiatric). All these processing rely on systems thinking and integration while using inter-professional collaboration to improve outcomes.

 

Articulate Learning:

Articulate learning of my experiences:

What did I learn?

Complex medical health issues coupled with a psychiatric disorder requires continuous reassurance and an environment of trust. This patient was in crisis and needed help. With nowhere to turn, this patient came to the facility despite her paranoia because she had no knowledge of where to find healthcare.

How did I learn it?

I learned this through observation by delivering the healthcare directly and empathizing with the patients. I take time to actively listen to patients and be their advocate throughout the healthcare process.

Why does it matter?

Part of social justice is providing underserved and vulnerable populations equitable access to care. By being the advocate, being transparent, and concerned, one gains trust and appreciation. Additionally, being responsive and efficient during the triage process creates an environment of caring, increases access to care for more patients within my community, and increases the probability of patient compliance to treatment.

What will I do in light of this?

I will continue to provide my services in an efficient and reliable manner. I will continue to advocate for the poor and disenfranchised by increasing my efforts in the SVDPFMC. Furthermore, the DNP role in in health promotion will require improving health outcomes; inter-professional collaboration; advocacy; designing preventative services such as screening, counseling, and public policy intervention.

 
References

Kovenbach, P. (2000, October). The service of faith and the promotion of

justice in American Jesuit higher education. Symposium conducted at Santa Clara University, Santa Clara, CA.

Chism, L. (2013).  The doctor of nursing practice:  A guidebook for role

development and professional issues.(2^nd ed.). Burlington, MA:

Jones & Bartlett.

The St. Vincent de Paul Society sponsors the Vocie of the Poor (VOP) which advocates for the underserved and vulnerable populations nation-wide including the homeless, poverty-stricken, and disabled. The following is a video produced by the national office of the VOP.

<iframe width="420" height="315" src="http://www.youtube.com/embed/zaM6gUHEF5s" frameborder="0" allowfullscreen></iframe>

“Never worry about the numbers. Help one person at a time, and always start with the person nearest you.”    Mother Teresa

 

Description of learning experiences in my clinical practice environment:

I completed 16 hours volunteering my expertise as a registered nurse (RN) in the Free Medical and Virginia G. Piper Dental Clinics (FMVPDC) offering nursing care for the working poor, the uninsured, and the indigent populations surrounding Phoenix metropolitan area.

What was the best/worst/most challenging thing that happened this semester?

The most challenging experience in the FMVPDC happen during my first 4-hour shift in which I triaged and cared for Mr. X, a 38 year-old Native American man who was complaining of a fever, night sweats, weight loss, poor appetite, and a persistent productive cough. He admitted to smoking 1 pack/day x 20 years, drinking 1 pint of alcohol/day for 8 years, and being an IV drug user. He had been seen previously in the clinic for ETOH abuse, tuberculosis (TB) treatment, and dental care. His clinical presentation included being gaunt, having tremors, febrile, hypotensive, hypoxic, tachycardic, and tachypneic. He was immediately referred to the staff physician for evaluation. He was also placed in a negative pressure isolation room and masked. I inserted an IV and gave him a fluid bolus. In reviewing at his previous work-up, he was referred to the county health department for Multi-Drug Resistant TB (MDRTB) and being HIV positive. This patient also received an antipyretic, an anxiolytic, and oxygen therapy. After he was stabilized he was transported to the emergency department of a nearby hospital for further evaluation and treatment.

On my third 4-hour shift in the clinic (1 month later), I encountered Mr. X in triage complaining of pain in his right antecubital area which revealed a hard mass over the right antecubital vein which was thrombosed and reddened. Once again, he was evaluated and sent by ambulance for further evaluation at a nearby emergency department.

Through dialogue with the social worker and Indian Health Service, we found out the patient was eligible for healthcare at the HIS hospital and eligible to receive public assistance and additional health care coverage for TB and HIV with the state and county agencies. The patient received long-term treatment with the Maricopa County Health Department and Phoenix Indian Medical Center. Additionally, the Centers for Disease Control (CDC) interviewed this patient because his strain of TB was unique. Furthermore, we were able to get Mr. X the treatment he needed and protect the other vulnerable populations from the spread of  MDRTB.

Examination of my experiences:

What did I accomplish?

I provided quality and effective care to an underserved population (indigent) which stabilized and improved the care at least one person received. I made the difference in people’s life, one person at a time. I was able to positively intervene in healthcare situations to affect outcomes. I provided a health care safety net to those without one. I enhanced my community by using the expertise of nursing.  

How did this experience affect my interactions with others?

I was able to be part of a community of caring individuals with similar goals who want to help the underserved and vulnerable populations in our society. Working with the social workers, clinic providers and nurses, and the others allowed me interact positively with community partners such the United Way, Salvation Army, Catholic Charities, and the Maricopa County Health Department.

What have I done differently as an individual and as a professional to support and advocate for some of the issues I encountered during your service learning experience?

Becoming a member of the Voice of the Poor (VOP) chapter in Phoenix has given me a platform for advocacy concerning human dignity and caring. The VOP works with state and federal agencies to provide a communal network to keep the “safety net” intact through policy and legislation at the municipal (local) level while being a base for issues related to poverty, immigration, and social justice.

Articulate learning of my experiences:

What did I learn?

Human caring is central to nursing interactions and is essential to optimizing health care delivery. In this environment, one must 1.) clear the mind; 2.) desire to understand; 3.) affirm the presence of the receiver; 4.) establish confidentiality; 5.) prepare to hear anything; 6.) actively engage in and encourage dialogue; 7.) avoid assumptions; 8.) follow intuition; and 9.) never give up (Schwerin, 2004). These attributes created an environment that was conducive to the clinic staff and the patients that received care.

How did I learn it?

I learned this through experience, the clinic staff members, and the clinical manager. Additionally, Schwerin (2004) states these tenets are the necessary building blocks of creating a caring connection.

Why does it matter?

Social justice— preserving of human dignity, protecting the poor, promoting solidarity and human equality—requires us to be kinder than necessary through the use of empathy, compassion, and resilience through adversity. Employing the techniques of human caring increases the interaction and responsiveness of the community to help each other and preserve human dignity.

What will I do in light of this?

Continue to serve my community and use my expertise to ensure access to healthcare for the underserved and vulnerable populations.

References

Schwerin, J. (2004). The timeless caring connection. Nursing Administration Quarterly, 28(4),

            265 – 270.

“Knowing is not enough; we must apply. Willing is not enough, we must do”--Goethe

 NR725B_WongPa_W8_ServiceLearningBlog

Description of learning experiences in my clinical practice environment: 

I have continued volunteering my expertise as a registered nurse (RN) in the Free Medical and Virginia G. Piper Dental Clinics (FMVPDC) offering nursing care for the working poor, the uninsured, and the indigent populations surrounding Phoenix metropolitan area. In 2011, this clinic saw 13,785 patients and had 160 health care professional volunteers on staff.

The clinic is a part of the St Vincent de Paul Society (SVDP) main campus which operates not only the clinics, but also a thrift store, a food bank, a free community cafeteria, homeless and victims of domestic violence shelters, an elementary school, youth and young adult programs for at-risk students , a  home, hospital and prison visitation program,  and a central processing facility for donations.

The St. Vincent de Paul Society’s mission is “to collaborate with others of good will in relieving need and addressing the causes by embracing all work of charity and social justice “(St. Vincent de Paul, 2012).  According to recent government statistics, 812,000 people live in poverty in Arizona out of 5,887,000 (total pop.) that represents 16.6 % of the total population and 40% of those living in poverty have no health insurance (National Coalition for the Homeless, 2012). This represents approximately 325,000 people who have no health insurance. Lack of health insurance is at a crisis not only in Arizona but nationwide. By offering free health and dental care with homeless sheltering, St Vincent de Paul has indeed demonstrated the leadership necessary to assist others in need and ensuring social justice and charity.    

            St. Vincent de Paul (SVDP) of Phoenix provided homeless services to 141,000 persons in 2011 and provided free medical and dental care to 13,785 patients. Additionally, SVDP provided 44,609 home visits, 12,450 visits to nursing homes, hospitals, and prisons, and provided 282,871 food boxes from the food bank (St. Vincent de Paul Society, 2012).  Additionally, the SVDP Society of Phoenix has developed a committee to advocate for the poor at a local, regional, and national level named “Voice of the Poor” (VOP). VOP has two purposes:  to educate members on issues effecting who they serve and to advocate for change in public policies detrimental to the poor.  By using the forum, SVDP has provided workshops on Welfare reform and changes in food stamp legislation. VOP was instrumental in removing the “kidcap” restriction in Arizona welfare laws, preserving the general assistance for the disabled, preserving social services for the needy, and raising unemployment benefits for AZ residents. VOP has also endorsed and were instrumental in passage of AZ Prop # 303 [which increased tobacco tax to fund AZ Health Care Cost Containment System (AHCCCS)] and AZ Prop 414 (created a special district to fund Maricopa Integrated Health System) which both laws have helped to increase the access to health care for the poor and uninsured.

The funding for this Free Medical and Dental Clinic services are derived from a perpetual grant from the Virgina G. Piper Foundation and the Society of St. Vincent de Paul. Additional funding is derived from sustaining contributions from the Diocese of Phoenix, charitable contributions/gifts, revenue from donations sold in the thrift store, grants from state and municipal organizations, federal block grants and the American Recovery and Reinvestment Act (ARRA).

Examination of my experiences:

        What am I trying to accomplish?

I am applying my skills as a RN in an environment requiring my services for an identified need within my community which includes ethnically diverse, underserved, and vulnerable populations in an urban area. I prepare patients to be seen by the medical provider by obtaining vital signs, chief complaint, and standardized (per protocol) diagnostic testing. Furthermore, I triage the patients according to severity of illness or injury so that resources are allocated judiciously and equitably.

     How does this experience affect my interactions with others?

I have synthesized my leadership and organizational skills to provide efficient nursing care by orienting new nursing staff and assisting in the redesign of the triage area of the medical clinic. Additionally, I have created a collegial environment with the social worker and the central referral center so that consults are processed quickly and providers have a central area to follow up on referrals and the outcomes of the consultations or hospital admissions. Furthermore, I have solicited area hospitals to donate expired medical supplies to the clinic.

      How does my understanding of social justice help me appreciate my role in healthcare?

I comprehend the ideals of social justice— preserving of human dignity, protecting the poor, promoting solidarity and human equality which leads to the improvement of the “common good”—supports social justice causes throughout my community. I make a difference by being a part of the solution for universal health care and being a part of a great organization by volunteering my time and lending my expertise as a multifaceted registered professional nurse to promote wellness, assist with access to care, and ease suffering. In addition, I have become involved with the Voice of the Poor (VOP) chapter in Phoenix.

Articulate learning of my experiences:

      What did I learn?

The poor and homeless appreciate the services I offer and are usually relieved after examination and treatment no matter how small the intervention. Also many are scared and worried about the impact of disease, illness, or injury will have on their activities of daily living (ADLs). Furthermore, many undocumented immigrants are suspicious of our activities until after treatment and discharge. Additionally, there are multiple constituencies with many agendas in healthcare. Depending on the point of view, the stakeholders may have conflicting views of how best to use available resources.

      How did I learn it?

I learned this through observation by delivering the healthcare directly and empathizing with the patients. I take time to actively listen to patients and be their advocate throughout the healthcare process.

     Why does it matter?

Part of social justice is providing underserved and vulnerable populations equitable access to care. By being the advocate, being transparent, and concerned, one gains trust and appreciation. Additionally, being responsive and efficient during the triage process creates an environment of caring, increases access to care for more patients within my community, and increases the probability of patient compliance to treatment.

     What will I do in light of this?

I will continue to provide my services in an efficient and reliable manner. I will continue to advocate for the poor and disenfranchised by increasing my efforts in the VOP. Furthermore, the DNP role in in health promotion will require improving health outcomes; inter-professional collaboration; advocacy; designing preventative services such as screening, counseling, and public policy intervention. I believe I am already providing many of the tasks involved in the DNP role (as previously stated); however, at present time, the clinic is focusing on immediate treatment and has little time to prepare for prevention strategies except in the dental clinic where we provide fluoride teeth-painting to 3-5 year olds in the community to prevent tooth decay. So, solid servant leadership would help health promotion strategies.    

References

National Coalition for the Homeless.  (2012). People need health care.  National

Coalition for the Homeless.  Retrieved from http://www.nationalhomeless.org/facts/health.htm

St. Vincent de Paul Society of Phoenix.  (2012).  Facts  and services .  St. Vincent de

Paul Society of Phoenix.  Retrieved from http://www.stvincentdepaul.net/.

NR725A_WongPa_wk16_SL Blog Entry#2

The under/uninsured, working poor, and indigent population I served at the St Vincent de Paul Free Clinic, have their basic and some preventative healthcare needs met. The services provided by the clinic addressed urgent needs such as wound care (suturing and monitoring for complications), cold and flu treatment, hypertension management, diabetes management, and well child care. Unfortunately, the healthcare needs of these populations require more than the clinic has to offer. For example, hypertensive or diabetic crises require more in-depth resources in an in-patient setting for treatment and management which in turn require hospital admission. Without health insurance, many of the patients served by the clinic will put off admissions due to lack of money and insurance until they are physically overcome by the disease or illness progression. In fact, one of my most challenging things happened when I encountered a 23-year old male patient who was experiencing left-sided abdominal pain for two weeks without relief from over-the-counter medications. Subsequently, a CT-scan revealed intestinal cancer but the patient initially refused more diagnostic testing and treatment because he could not afford the cost of treatment. Although I counseled him about the gravity of non-treatment, he still refused. I involved the social worker and the clinic physician in a discussion about this case and fortunately the social worker was able to enroll this patient in an emergency temporarily funded state health insurance program for just these types of patients. After several attempts to contact the patient, we were able to secure a referral to oncologist who managed the patient as an outpatient through his initial phase of treatment. At this writing, I have lost contact with this patient for follow-up.

Services such as the St Vincent de Paul Free Clinic (SVDPFC) is a necessary fixture for this community as well as communities across the nation. This facility acts as a safety net for those who cannot afford insurance and those who are deemed ineligible for insurance. Additionally, services like the SVDPFC extend their human caring to undocumented immigrants who are suspicious and cautious about seeking health care (especially preventative care). In these uncertain times and decreasing financial support for charities, the SVDPFC needs more facilities like themselves to accommodate an increasing number of people requiring their services. In fact, Maricopa Health System (a county-run agency) has decreased the number of clinics county-wide and has started to require residency documentation in order to use their services. The means to provide more services such as the SVDPFC and diminishing rapidly without an alternative solution therefore I fear the Free Clinic will be overwhelmed if the Affordable Healthcare Act of 2010 (AHA) is repealed by the Supreme Court. With this in mind, I am obligated as a member of my community, as a professional nurse, and as a Christian to continue my services with SVDPFC in order to promote the common good, care of the less fortunate, and the infirmed.

Throughout my service learning at the SVDPFC, I have learned that I have deep inspiration for political and social advocacy. I have attended several community action boards with State legislators concerning cuts in Medicare funding and have worked diligently to provide quality nursing care to the underserved and vulnerable populations within my community.  Additionally, I have gained insight to fragmentation of community resources for the under/uninsured, the working poor, and the indigent populations within society.  Furthermore, I have gained compassion, sympathy, and empathy for those who are less fortunate and fear for their safety.

Last Words for the Semester:  "When a poor person dies of hunger, it has not happened because God did not take care of him or her. It has happened because neither you nor I wanted to give that person what he or she needed." --Mother Teresa

NR725A_WongPa_W8_SL_ReflectionsBlog1

“Never doubt the power of a small group of committed individuals

to change the world; indeed, it is the only thing that ever has.”

Margaret Mead

As part of the Society of St. Vincent de Paul (SVDP), The Free Medical and Virginia G. Piper Dental Clinics offer medical and dental care for the working poor, the uninsured, and the homeless population in the surrounding Phoenix metropolitan area. The funding for this service is derived from a perpetual grant from the Virgina Piper Foundation and the Society of St. Vincent de Paul. I believe that SVDP has internalized the building blocks of Catholic social teaching :  preservation of human dignity, respect for human life, association, participation, protection of the poor, solidarity, stewardship, subsidiary, human equality, and “the common good” (Byron, 1998, p. 2 - 6). My service learning experience is working as a RN in the evening health clinic providing nursing care to pediatric and adult populations requiring medical treatments and nursing interventions. The rationale for choosing this site and this environment for my service learning experience is three-fold:  St. Vincent de Paul mirrors my values and beliefs; I can use my professional skills and experience to make a difference in people’s lives; and I can ease the suffering of the citizens within my community.

My role at the Free Clinic is as a staff registered nurse (RN) working with a compassionate group of healthcare providers which includes nurse practitioners (NPs), physicians, social workers, physician assistants (PAs), and registered  dietitians. In the clinic, I administer medications, apply splints and casts, obtain vital signs, create referrals, and document the encounters. I have worked 2-3 hours per week on the evening shift (the busiest part of the day) providing nursing assessments and interventions—that’s a total of 12 hours as of this posting. For example, a middle aged indigent man with diabetes and a gangrenous left foot came in for evaluation. While cleansing the foot and the associated ulcer, I was able to assess the foot for the absence of pedal pulses and capillary refill. Additionally, I was able to solicit a detailed medical and psychosocial history which included moderate bipolar behaviors and schizophrenia.  Furthermore I will able to ascertain that he was a Vietnam-era veteran. Through the use of the social worker and the Veterans Administration, we were also able to get this patient a referral for behavioral health, a hospital to perform the amputation, and a prosthetic device, as well as a post-operative rehabilitation plan. This was just one encounter of many in which the opportunities to make a difference in people’s lives are limitless yet realistic. In fact, I have been asked to help with the community diabetes outreach program and the pediatric dental caries prevention program. Just recently, one afternoon, we went the local mall for a few hours and provide fluoride teeth painting to children 3 – 5.  My long term plans include assisting the manager of the Free Clinic in performance improvement projects such as patient wait time reduction, referrals processing, and cost containment issues. Additionally, I would like to do more community projects such as diabetes teaching and exercise.

I would like to leave you with an inspirational quote that sums up my passion and service learning experience:

“Far and away, the best prize that life has to offer is the chance to work hard at something worth doing”—Theodore Roosevelt

Byron, W. J. (1998). Ten building blocks of Catholic social teaching.  America, 179(13), 9-13.