“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.