Nursingmatters October 2016 • Volume 27, Number 8
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INSIDE: What if dry needling is the answer?
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Take a look back at UW-Milwaukee
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Mix and mingle!
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Community partnership sets future education tone Colleen Gullickson
In 1995, Northeastern University Assistant Professor Peggy Matteson wrote a book entitled, “Teaching Nursing in the Neighborhoods,” published by Springer Publishing Company, in which she describes “a model of clinical education in which nursing students receive 50 percent of their clinical experiences in the community – often in settings where no other kinds of health care services are available.” Matteson discusses the need for baccalaureate nursing faculty to embrace educational challenges inherent in a rapidly changing health-care arena and provides a compelling argument for curricular re-design – one that provides greater emphasis on community and primary care. Fast-forward 21 years to 2016. The Affordable Care Act has become law. Yet the same academic conversations regarding the need to educate students for success in a changing health-care system are still happening while curricular change progresses at a glacial pace. In our curriculum, nursing students begin their first semester in the community, focusing on health promotion in school-aged children and older adults. Second-semester students are placed in an acute-care surgical setting for 16 weeks. Third-semester students are traditionally placed in a setting that provides opportunities to care for individuals and families during a longer period of time than a typical hospital stay. Students are placed in rehabilitation units, medical units, hospice or the Community Living Center at the Madison Veterans Administration facility. Fourth semester is divided, with eight weeks in pediatrics and eight weeks in maternal or child inpatient units. Fifth-semester students are placed in public health. That clinical experience differs from the first-semester community health-promotion focus in that students are placed in county health departments. Students learn the core functions of public health and caring for aggregates based on strategic initiatives derived from state and national health priorities – in addition
Senior-level nursing students work with children in Bayview International Center for Education and the Arts’ after-school program. The nursing students are building trusting relationships that will support them in developing interactive lessons to help improve health outcomes for the kids.
to experiencing how public health differs from community health. During the fall 2015 semester, the Henry Predolin School of Nursing at Edgewood College in Madison, Wisconsin, began offering community-based medical and surgical in the third semester, and pediatric and maternal or child in the fourth semester – clinical experiences for a group of clinical students preferring a setting other than the more traditional acute-care clinical options. Third-semester community students in this community-based clinical program work with underserved clients in one of Madison’s largest public-housing developments. With the help of onsite personnel, students build their own caseloads during
the 16-week semester. The site offers students a wide variety of experiences that include providing health-promotion education to individuals and groups of clients, working as a member of an interdisciplinary team, attending primary-care appointments with clients, supervising medication management and diabetic care, and assisting clients in navigating the healthcare system. Through these experiences, students develop a deep understanding of the challenges clients routinely encounter in attempting to manage their chronic illnesses. One student, who was asking to be excused from a nursing class to attend a clinic appointment with her client, said to her instructor, “Professor S, you don’t understand. This isn’t like in the hospital where someone else can pick up for you if you’re not there. My client is counting on me to be there and help her.” Two other students summed up the value of their experiences, saying the community clinical had been eye-opening.
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October • 2016
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Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713 Editor........................................... Kaye Lillesand, MSN 608-222-4774 • kayelillesand@gmail.com Managing Editor................................... Julie Belschner 608-250-4320 • jbelschner@madison.com Advertising Representative.................... Teague Racine 608-252-6038 • tracine@madison.com Recruitment Sales Manager.......................Sheryl Barry 608-252-6379 • sbarry@madison.com Art Director...........................................Wendy McClure 608-252-6267 • wmcclure@madison.com Publications Division Manager.................. Matt Meyers 608-252-6235 • mmeyers@madison.com Nursingmatters is dedicated to supporting and fostering the growth of professional nursing. Your comments are encouraged and appreciated. Email editorial submissions to klillesand@sbcglobal.net. Call 608-252-6264 for advertising rates. Every precaution is taken to ensure accuracy, but the publisher cannot accept responsibility for the correctness or accuracy of information herein or for any opinion expressed. The publisher will return material submitted when requested; however, we cannot guarantee the safety of artwork, photographs or manuscripts while in transit or while in our possession.
EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NURSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at UW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor UW-Eau Claire School of Nursing, Eau Claire, WI © 2015 Capital Newspapers
Nursingmatters
WHAT IF ...
What if Dry Needling is an answer to Chronic Pain? What is dry needling? It’s similar to acupuncture in that it uses fine solid-filament needles. It involves looking for knots or trigger points in muscle, and stimulating or engaging muscle fibers by inserting a needle into the knotted muscle. Sometimes therapists twist the needle to aid in releasing trigger points. The needle may cause a twitch or muscle contraction, which might be accompanied by a cramping feeling that often signals the release of the muscle fibers. Although it is often painful, it is also usually accompanied by pain Brenda Zarth relief and improved range of motion. The National Association of Myofascial Trigger Point Therapists advises that “stress and injury are the two major culprits behind trigger-point formation. In addition to direct injury to the affected area, other common causes of these ‘contracted knots’ include repetitive overuse injuries, sustained loading, poor posture, clenching muscles when stressed and prolonged inactivity.” Dry needling evolved out of trigger-point injections. Trigger-point injections might inject local anesthetic, saline or Botox – but it was discovered over time that it didn’t seem to matter what was injected. It seemed that patients received benefit from the physical insertion of the needle. The downside
Partnership
continued from page 1 They said they were thankful for the opportunity because it allowed them to see the many different roles a nurse can have. It also, they said, emphasized the need to have a holistic approach and find the underlying issues that a patient is struggling with. They said they are confident the experience will make them better nurses. The community clinical was a profoundly enriching experience, one student said, that completely reshaped the kind of nurse that person wanted to be. Because of that experience, the student will now approach any client anywhere with a level of care and compassion that the student never would have known otherwise. Following 16 weeks in the community
Dry needling is similar to acupuncture in that it uses fine solid-filament needles. It involves looking for knots or trigger points in muscle, and stimulating or engaging muscle fibers by inserting a needle into the knotted muscle.
of trigger-point injections is that hypodermic needles are much larger than solid-filament needles and therefore may disrupt the tissue more and cause more bleeding. Fewer trigger points can be treated at a time. Local anesthetic that is used numbs the area for one to two hours, but after that post-treatment soreness is reportedly similar to dry needling. Trigger-point injections are usually covered by insurance because they are performed in a doctor office visit. Dry needling is done by many different health professionals, including physical therapists who have undergone additional training to become certified in dry needling. Dry needling can be done to superficial muscles to cause relaxation, or to deep muscle fibers to activate them. “What has happened over recent years because of new research, we’ve learned that a well-placed needle right into a trigger point or right into the soft tissue can reset that muscle with less pain and less work than sometimes even my hands could do,” said Gray Cook, physical therapist.
“You’ll point at your thigh saying, ‘Can you get rid of this trigger point for me?’ We can rub on it and we can do other things. It’s a superficial trigger point, so I can get to it with my thumbs, but you never have any long-term relief. Every time you stress yourself out, your thighs get jacked up again. When we needle the thighs, we have a relaxing effect on the thighs, but when we needle the deep muscles of the hip, we have an activating effect. Whether your muscle is overacting inappropriately or under-acting inappropriately, the needle seems to have a normalizing effect. It’s one of the best reset buttons I’ve seen. It’s not as painful as deep-tissue work. It doesn’t take as long as electrical stimulation or ultrasound. There’s an immediate feedback, so we know within two or three minutes of treatment if we changed anything, from both a pain standpoint and a movement standpoint.” Visit http://graycook.com/?p=1151 for more information. Email BrendaZarth@gmail.com or visit brendashealthplan.blogspot.com with comments or questions.
setting, students move to maternal or child and pediatrics in the community. For pediatrics, students gained experiences in a multicultural neighborhood adjacent to their clinical sites from the previous semester. At the Bayview International Center for Education and the Arts, students worked with school-aged children and middle-school young adults. Initially site organizers requested “homework assistance” in the after-school program. But nursing students quickly learned that assisting with homework was a gateway activity to becoming accepted and trusted as outsiders. After a few homework sessions, nursing students noticed that several of the young children might benefit from educational instructions regarding oral hygiene. With permission from the site liaison, nursing students developed a
teaching session on oral care and arranged for a dental hygienist from a dental office come with free toothbrushes and toothpaste to provide education on dental self-care. In another situation, one male nursing student overheard middle school boys laughing about a website showing scantily clad young women, adding derogatory remarks. The nursing student believed it might be a good opportunity to discuss sexuality and healthy relationships – but were sensitive to the fact that it was a multicultural neighborhood with a large Hmong population. The nursing students were concerned about what the parents would allow, and about what the cultural norms are. With permission, nursing
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Partnership
continued from page 2 students offered an after school role-playing game where participants would pick a scenario from a grab bag and role-play with other attendees “what would you do if. . .” The teaching session was so popular, participants did not want to leave. They stayed past the scheduled time while suggesting their own situations they wanted to role play. Simultaneously, during the 16-week semester, students also had maternal and child community-based experiences. Group Health Cooperative of South Central Wisconsin is a strong partner with the Henry Predolin School of Nursing; the cooperative offered students the opportunity to spend time in its obstetrics clinics learning prenatal care and newborn assessment, along with postpartum care, while working with a lactation consultant. Students also worked with pregnant women in a community-based licensed residential facility. The women in the facility had all been assessed as having a substance-abuse problem in addition to a criminal conviction. Students attended clinic appointments with their clients and helped develop birth plans along with developing an educational teaching session entitled “Baby Basics.” Two students were ultimately asked to attend deliveries as support persons.
October • 2016 Student comments suggest maturation in their thinking about caring for underserved populations. One student said, “It drastically changed how I feel about those that struggle with substance abuse.” Another student commented, “I’ve learned how to empathize with people from very different backgrounds and life experiences. The entire experience was bittersweet.” Faculty have been working to expand community experiences in both the medical and surgical clinical, as well as the pediatric and maternal or child clinical. Because this clinical offering is new for students, faculty and the hosting sites, faculty members have done considerable work initially to ensure a strong, mutually beneficial partnership between the school and the site. “Community” and “Partnership” are two core values of Edgewood College, and, as such, have guided college staff as they explore clinical-site placements. Clinical faculty are on site with the college’s students as they navigate a new practice setting, expanding the boundaries of their practice and developing professional autonomy. In addition, part of site development requires mutual planning that addresses site needs as well as learning opportunities for students. Commitment, trust and continuity are important building blocks to ensure community partnerships thrive.
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By working in a neighborhood, nursing students learn the core functions of public health and caring for aggregates based on strategic initiatives derived from state and national health priorities – in addition to experiencing how public health differs from community health.
One faculty member has been asked to serve on the community advisory board where she supervises students. Other faculty have been invited to attend community-sponsored neighborhood festivals. Each of these actions suggests a commitment
between the faculty and School of Nursing, and the communities served. Kim Walker, MS, RN, taught the first group of students in the community.
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October • 2016
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Nursingmatters
Remember UW-Milwaukee alumni Editor’s note: As a part of the University of Wisconsin-Milwaukee College of Nursing’s 50th Anniversary, staff have created a booklet recognizing 50 distinguished alumni. “These 50 distinguished alum profiled exemplify the tradition of excellence that characterizes UWM nursing,” it says. I so enjoyed reading the profiles I thought you would enjoy them as well.
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Part of the NURSINGmatters mission is to recognize the accomplishments of Wisconsin nurses. If any of you have stories of nurses who have “made a difference” please send them to us to share in our publication – email me at kayelillesand@gmail.com to send stories or photos, or to ask questions. –
CORRECTION: In the previous issue of Nursing Matters, these alumni were shown as having graduated from a different university. They are UW-Milwaukee alumni. We are re-running these alumni with the correct information. We regret the error.
Kaye Lillesand, Editor Nursing Matters
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October • 2016
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■ Materials Management Assistant Part time position available to perform and participate in the decontamination and distribution of instruments, equipment and supplies. ■ Certified Medical Assistant Full time position available at Mile Bluff Clinic. Duties include rooming patients, taking vital signs, assisting with procedures, utilizing EHR for documentation, phone communication and more. ■ Physical Therapist/Physical Therapy Assistant Full time position available in our Rehab Services department to cover both outpatient orthopedic patients as well as work in our short term rehab setting. Experience preferred. ■ Health Unit Coordinator Part time position available in our Emergency Department. This position is for the Day shift, every other weekend. ■ Recreation Aide Full time and part time positions available at Crest View Nursing & Rehabilitation Center. Experience preferred. ■ Data Analyst Full time position available in our Quality Assurance department. This position is responsible for identifying, analyzing, and interpreting data from a variety of clinical, financial, and demographic sources in relation to the goals and mission of Mile Bluff Medical Center. Minimum education as a graduate of an accredited nursing program, or health related field, and at least three years of related work experience. ■ PC/Network Technician Full time position available in our IT department. Responsibilities include pc configuration and support along with software and other hardware support. Minimum three years on the job experience preferred. VMWare experience a plus. ■ Radiologic Technologist Full time position available at Elroy Family Medical Center. Candidate must be AART certified or eligible to take exam. ■ Resident Care Assistant Part time position available at Crest View Nursing & Rehabilitation Center, will include PM and Night shifts. CBRF certificates required. ■ Recreation Aide Part time position available at Fair View Nursing & Rehabilitation Center, mainly for the PM shift. ■ Cook/Food Service Worker Full time position available in our Food & Nutrition department. ■ Food Service Worker Part time position available at Crest View Nursing & Rehabilitation Center. ■ Certified Nursing Assistant positions available: ➢ Part time position available in the Medical/Surgical department. Experience preferred. ➢ Full time and part time positions available at Fair View Nursing & Rehabilitation Center for all shifts. ➢ Full time and part time positions available at Crest View Nursing & Rehabilitation Center for all shifts. ■ Registered Nurse positions available: ➢ Full time position available at Fair View Nursing & Rehabilitation Center. ➢ Full time position available for a Family Practice RN at Mile Bluff Clinic. Minimum two years of experience preferred. ➢ Part time position available in the UW Specialty Clinic for triaging patient calls and working with UW Providers and patients. ➢ Full time position available in the Medical/Surgical department for a Wound Care RN/Specialist. This is a Monday-Friday day shift position. Accredited/current wound care certification desired, minimum of two years recent wound care preferred. ➢ Full time position available in the Medical/Surgical department for a 12 hour Night shift RN. Experience preferred, new grads will be considered. ➢ Charge RN, full time position available in the Medical/Surgical department. This is a 12 hour Night shift position. ➢ Triage/Family practice, full time position available at New Lisbon Family Medical Center. ➢ Full time position available at Crest View Nursing & Rehabilitation Center. ➢ Part time position available at Crest View Nursing & Rehabilitation Center to work every other weekend.
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Partnership
continued from page 3 “It has been a very humbling experience to work with the residents in their community where they have so little and have many struggles and challenges to face each day,” she said. “I strive to teach my students that community nursing with adults with chronic illness is a journey that is enhanced by walking a day in their resident’s shoes, respecting and meeting each of them where they are, and that the definition of health is a holistic approach and is uniquely defined by each resident.
This is the most difficult concept for students to grasp, coming from a structured health-care institution and into someone’s home or environment, particularly with the many disparities the population holds. We strive to support, educate, assess and guide the residents with this journey as we hope to continue to create autonomy, independence and confidence to a population and community that needs to be respected and welcomed.” Erika Helmer MS, RN, APNP, along with Bethany Saddler DNP, RN, worked to develop the first pediatric and maternal or child experiences.
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October • 2016
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“As faculty in the community, with students working towards their (bachelor of nursing), I truly feel that we are gaining insight into the human experience,” Helmer said. “The value of meeting individuals and/or groups in their own space – home, community clinic, residences – allows us something we cannot teach in the classroom or acute-care setting. This experience teaches us to accept at a deep level and interact with clients who may be very different from ourselves and our own backgrounds. We have to get creative and find a way to communicate and connect – that is really the essence of
nursing practice.” As the college begins its second year offering community-based clinical experiences, faculty look forward to including a wider variety of opportunities for student learning. Despite being 21 years overdue, “Teaching Nursing in the Neighborhoods” has become a reality for Edgewood College nursing students and faculty. Colleen Gullickson, Ph.D., RN, is a professor and associate dean for undergraduate programs at Henry Predolin School of Nursing, Edgewood College, in Madison, Wisconsin.
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