Minot Daily News SATURDAY, APRIL 4, 2020
Health Care
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Home-grown nurses Rural hospitals play role in filling nursing shortage By JILL SCHRAMM
Senior Staff Writer jschramm@minotdailynews.com Sarah Gregg is a homegrown nurse who now helps train others to become nurses in her home community of Harvey. Nurses like Gregg are part of the success story of the Dakota Nursing Program, which brings together college nursing programs and rural hospitals to address the state’s nursing shortage. Gregg said she had just moved to Harvey in 2011 when she heard about the program. She already held a bachelor’s degree in biology and was an Emergency Medical Technician, which easily fulfilled the prerequisites to secure a spot in St. Aloisius Medical Center’s first nursing class. “I think it would actually have been impossible for me to pursue nursing at that point in my life had I not had the program in Harvey. We are at least an hour or two hours away from Bismarck or Minot,” Gregg said. Gregg, who became the nurse educator at St. Aloisius last August, is a registered nurse working toward her master’s degree. Of the 19 graduates since the program’s start in Harvey in 2011, seven are employed at the local nursing home and Gregg works at the hospital. Gregg said the accelerated course is intensive for students during the 11 months of practical nurse training and additional nine months for registered nursing training. The result is a high quality education, though, she said. “We put out very good nurses, very competent nurses,” she said. Three students currently are
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ABOVE: Bismarck State College nursing instructor Sarah Gregg, RN, left, stands with her students in a licensed practical nursing class at the Harvey site. From left are Michele Frank, Heather Osborn and Jessica Coombs. LEFT: Harvey nursing students Jessica Coombs, left, and Heather Osborn, engage in a pediatric simulation inside Bismarck State College’s new simulation truck.
enrolled in an LPN course in Harvey. Gregg said she hopes to spur increased enrollment because the local medical community still needs more nurses. The hospital has had to rely on traveling staff to meet its needs. Across the state, the Dakota Nursing Program has 195 students enrolled in the LPN training and about 140 in the associate-degree RN training, said Julie Traynor, program director, Devils Lake. The program trains more than 300 practical nurses and associate-degree nurses each year through the four participating colleges. Training is of-
fered in 15 locations across North Dakota through a combination of face-to-face lab and clinical courses and theory courses over Interactive Video Network and online formats. Dakota College at Bottineau offers program sites in Minot, Rugby and Valley City. Williston State College offers the program in Tioga. Bismarck State College works with Ashley, Garrison, Harvey, Hazen and Hettinger, while Lake Region State College has programs in Grand Forks and Mayville. Tioga Medical Center recognized the need to serve as a host facility after a nurse training
program in New Town closed. There were two local instructors in the New Town program who were recruited to teach part-time at the hospital. The medical center now is training a second class of eight future LPNs, having graduated five in its first class. The program was in the process earlier this year of attaining certification to offer an RN program. Once eligible to offer both LPN and RN programs, the intent is to alternate the courses each year, said Ryan Mickelsen, chief operating officer at the hospital and advisory board member for the program.
So far, students have come from outside Tioga’s medical system, but Mickelsen said the hope is to recruit in-house certified nursing assistants to adtheir educations. vance Students have largely been from the local area, though, including Tioga, Ray, Stanley, Crosby and Williston. The program can take up to eight students in a class. “Our hope is to get them in our system, see how we operate and want to come work for us,” Mickelsen said. So far, one LPN has joined the medical center, which has been forced by nursing shortage to look to contract nurses. Remaining LPN graduates have gone on for RN training. CHI-St. Alexius Hospital in Garrison started its LPN program two years ago. The hospital recently was approved by the Board of Nursing to begin an RN program this fall. Tod Graeber, administrator, said the Garrison program can take up to eight students at a time. It had six students who came from Garrison, Turtle Lake and Underwood the first year and currently has three students. So far, all have been going on to the RN program.
Preventing diabetes By JILL SCHRAMM
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Shelby Stein, community dietitian, with the Fort Berthold Diabetes Program conducts a healthy cooking class in August 2019.
eating out and setting up home and work environments in ways that encourage healthy food choices. Participants get a short cooking demonstration or have a healthy snack prepared for them with a recipe offered. They review local restaurant menus and learn how to make the healthiest selections from those menus. Another major component of the course is physical activity. Partici-
pants are encouraged to engage in at least 150 minutes of activity each week. Stein said those activities can be as simple as taking a walk. “It’s literally anything participants want to do as long as people are moving,” she said. Participants receive information on different exercises and ways to motivate themselves to exercise. “Through the combination of those diet changes and the course on
physical activity, the goal is, hopefully, to promote weight loss,” Stein said. “Research does show if we can lose about 5 to 7 percent of our body weight, if we are overweight to begin with, that can greatly reduce our risk of developing Type II diabetes.” The six-month follow-up after the four months of classes aids in creating accountability so people maintain lifestyle changes. “The goal of those six follow-up
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Fort Berthold Diabetes Program helps tribal members avoid disease
Senior Staff Writer jschramm@minotdailynews.com NEW TOWN – One in three American adults has prediabetes, putting them at risk for eventual diabetes, according to the U.S. Centers for Disease Control and Prevention. The Fort Berthold Diabetes Program looks not only to assist those living with diabetes but also works to help people avoid developing the chronic illness. In recent years, it has offered the National Diabetes Prevention Program to educate people at risk about healthy lifestyles. The most recent offering was in the fall of 2018. A class proposed to start in March was put off due to coronavirus precautions. The goal of the program is to prevent Type II diabetes, said Shelby Stein, registered dietitian with the Fort Berthold Diabetes Program. To participate in the program, a person must have been diagnosed with prediabetes or carry a risk of developing Type II diabetes or have had gestational diabetes. The class draws participants from their late 20s into their 70s. “Being Native American puts people at a higher risk of developing diabetes,” Stein said. “The aim of the program is to teach different lifestyle changes that help reduced the risk of diabetes.” A major focus of the diabetes prevention program is nutrition, and the course goes into detail on how people can eat healthier, Stein said. It teaches how to make healthier choices when
About half have come into the program as certified nursing assistants. Graeber said the initial idea was to recruit CNAs, provide them some financial help or loan repayment as incentives to work at the facility after graduation. Two students finishing their RN training in May have agreed to come back to Garrison, and Graeber said there is a possibility of others doing the same. These are nurses the hospital would not have were it not for the program, he said. The Garrison hospital has recruited international nurses to address its staff shortage, but still has had vacancies. In addition to the in-patient care, the hospital has a 28-bed nursing home. The Benedictine Living Center in Garrison, which has partnered on the nursing training program, has a 50-bed home. Graeber also is administrator for the Turtle Lake hospital. He said it was at a North Dakota Hospital Association conference that staff from both Garrison and Turtle Lake saw what other hospitals were doing with the Dakota Nursing Program
months is to keep people engaged and keep them on track,” Stein said. “Sometimes with lifestyle changes like exercise routines, we kind of fall out of those habits when we don’t have a good group to keep us motivated.” Many people who complete the program report that they are using the tools they learned and maintaining their changes long-term, Stein said. The hope is they will take what they learned into their homes and change family habits that impact the diabetes rate for future generations, she added. “Everything we do here is geared toward a family approach,” Stein said. “This isn’t just something we want you to do but it’s the same nutrition guidelines and activity goals that everyone in the whole family should be doing. There’s nothing extreme or drastic in this program. It’s just focused on healthy lifestyle changes.” In 2019, Elbowoods Memorial Health Center in New Town and its field clinics in Mandaree, Twin Buttes, Parshall and White Shield served 6,790 patients, and 845 of those patients had diagnosed diabetes. The 12.4% is close to the 13% rate for all U.S. adults estimated by the CDC in 2018. Education and services through the Fort Berthold Diabetes Program and the clinic have helped lower the diabetes rate, Stein said. Local availability of the continuous glucose monitoring system, which enables people to monitor blood sugar without drawing blood with a needle prick, also has been made a difference, she said.
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Minot Daily News • PROGRESS: Health Care
Saturday, April 4, 2020
Taking action against opioids Minot clinics offer addiction treatment
By KIM FUNDINGSLAND
Dina Goodman, counselor at Goodman Addiction Services of Minot. Staff Writer kfundingsland@minotdailynews.com “There’s a lot of opioids and more methamphetamine in the last six Counselors and patients agree, months than a year ago. It goes in there’s a very big need for opioid spurts.” Ideal Option is another addiction treatment in Minot. While the real number may be unknown, some treatment facility in Minot. The clinic with knowledge of the problem esti- has limited hours as posted on their mate the number of heroin addicts website. There too, says Jane Sveen, seeking treatment at 5% or less. Nev- the need for treatment in the Minot ertheless, even with that small per- area is clear. Sveen is with Ideal Opcentage, Minot’s addiction treatment tion in Bismarck. “We don’t currently have a fullcenters are very busy. “Right now were are serving 215 time provider on site in Minot,” exor so clients from Minot and the sur- plained Sveen. “We do have some rounding area and it is steadily in- hours to come and be seen by creasing,” said Bridget Malone, telemed. We want everyone to know manager of Community Medical we’re here.” The goal of all the addiction treatServices of Minot, which is also known as the methadone clinic. ment clinics is to allow addicts to re“The need is a lot higher than we are turn to a much more normal lifestyle, serving. There’s definitely more peo- free from the influence of drugs. One of the first hurdles to overcome, once ple that need services.” Laura Larson is the behavioral a person commits to removing themhealth director at Northland Com- selves from the burdens of drug use, munity Health Center of Minot. It is is going through withdrawl. “With opiates, often they are lookthere that addicts receive treatment through a combination of medica- ing at pretty severe withdrawl symption, case management and counsel- toms,” said Goodman. “It’s not that they don’t want treatment, but rather ing. “They are most successful when less painful detox.” Community Medical Center pridoing all parts of the process – medication, support and counseling,” marily relies on methadone to treat said Larson. “There’s definitely a big heroin addicts begin their withdrawl need in this state and nationally. It’s program in what they describe as a “medication-assisted treatment in a problem.” “We often refer to Community conjunction with psycho-social Health Services and Northland,” said counseling” as treatment for opioid-
Kim Fundingsland/MDN
Ideal Option of Minot treats those addicted to opioids and other substances using medications like Suboxone and Vivitrol. According to the clinic’s website, patients are “treated with empathy, care and respect – never judgment or reproach.”
Kim Fundingsland/MDN
Community Medical Services of Minot, sometimes referred to as the methadone clinic, uses a combination of outpatient medication-assisted treatment and counseling to assist addicts in their recovery process. use disorders. “Everybody is welcome. We don’t expect anybody to be drug free,” said Malone. “They can call or stop in anytime. It’s a laid back atmosphere, not intimidating. It is different for everyone. Quite a few people that have completed the program stay on it, get stable, find jobs and rebuild their lives.” Goodman said treatment includes an “intensive out-patient program”
for those who are staying in the community. “We have evening programs so they can keep their job, pay rent and not lose their homes,” said Goodman. Often addicts are willing to engage in criminal acts, such as burglary, to support their drug habit. That leads to possible incarceration which has not proven very beneficial to changing an addict’s life-style. A
better method, say many professionals, is treatment. “Success comes for us when we know clients are physically feeling better, back at their jobs and family and community,” said Larson. “They go to work and contribute to the community. They are feeling healthy and feeling well.” At Ideal Option the main treatment for those addicted to heroin is usually a combination of Vivitrol and counseling. Vivitrol is used to prevent a relapse of opioid dependence after detox. “It’s an amazing drug,” said Sveen. “I really have not seen it fail. It really helps people feel better. Our goal is to keep addicts comfortable as long as it helps them. We expect relapse, but then we still work with them. It is a disease. If a person has a safe place to live, a vehicle, a job and a relationship, they do very well.”
Mammography to MRI CHI St. Alexius in Minot offers full service imaging By CIARA PARIZEK
Staff Writer cparizek@minotdailynews.com CHI St. Alexius Health Minot Medical Plaza staff work efficiently to get their patients’ results back to them within 48 hours with their state-of-the-art imaging equipment. One of their amazing machines does 3D mammograms. By using the new technology, it scans the breast tissue and shows each layer. Jennifer Lemon, a mammographer and radiologic technologist, said the 3D mammogram is considerably more thorough than a regular mammogram and gets a lot more detail. Both of their X-ray rooms have Siemens Multix Fusion diagnostic machines. The images from the machine go straight to the monitor behind the window for the tech to look at. The radiation from the machines is also low dose. Plates stand in the back of the rooms for patients who have to get upright X-rays taken of their upper body or get special scans they may not be able to take while the patient is lying down. The rooms are also rather large, allowing ample room for patients for weight bearing or standing X-rays or be brought in on a stretcher on rare occasion. Across the hall is a dual-energy X-ray absorptiometry (DEXA) machine. The
purpose of the DEXA machine is to check patients’ bone density. It also tells the tech if the patient is at risk of osteoporosis, a condition that causes the bones to become brittle. To scan the soft tissue, like muscles, tendons and ligaments, they use magnetic resonance imaging, or MRI. Darcie Hansen, a CT and radiologic technologist, said some cases require faster results, like searching for brain bleeds or ruptured organs. To get those urgent results, St. Alexius staff perform a computed tomography (CT) scan. They offer a wide variety of exams and also have a complete lab to do necessary tests. Their scheduling is quick, as well as the time in which they can have the results out to the patient. As long as St. Alexius has authorization from the patient’s health insurance provider, the can be checked the same day and their results will be available within 48 hours. If their case is deemed emergent, they can have the results back even sooner. In addition to seeing their own patients, they also offer services to those who need to see a primary care provider if a patient’s original primary is booked. Lemon and Hansen are both available Ciara Parizek/MDN to answer any questions people may have about their services and said they are more Darcie Hansen and Kelly Binek demonstrated lining up for a CT scan at than happy to answer them. CHI St. Alexius Health Minot Medical Plaza on March 12.
Photos by Ciara Parizek/MDN
LEFT: Darcie Hansen lines up the DEXA machine to show how to get a scan of Beth Burckhard’s spine on March 12 at CHI St. Alexius Health Minot Medical Plaza. MIDDLE: The ultrasound technologist, Kelly Binek, scanned Anthony Owens’ neck on March 12 to check his thyroid at CHI St. Alexius Health Minot Medical Plaza. RIGHT: Beth Burckhard demonstrated how she lines up a patient’s shoulders and spine on March 12 for a chest X-ray at CHI St. Alexius Health Minot Medical Plaza.
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Saturday, April 4, 2020
Minot Daily News • PROGRESS: Health Care
Safety top priority Safe Kids Minot spreads awareness By CIARA PARIZEK
Staff Writer cparizek@minotdailynews.com Amber Emerson with Safe Kids Minot is doing all she can to help parents in the community keep their kids safe in all aspects of their lives. Safe Kids is a worldwide project whose goal is to lower the amount of child injuries and deaths each year. They get closer to their goal by informing parents or soon-to-be parents about keeping their children safe in many different situations. One of the boards that Emerson puts on display at events is geared toward parents and giving them tips on keeping medications up and out of the reach of children. Sometimes she has an example of a pill disposal bag that makes the medication unusable by turning into a jelly and neutralizing it. At the sports show that takes place in Minot in the second weekend of March, a Safe Kids Minot board listed ways to be safe while out hunting, on the lake and on all-terrain vehicles. At the North Dakota State Fair in 2019, Emerson had tables set up under a giant canopy. One table had a large colored wheel that had questions on it that kids could spin and ask the question it lands on. She also used the wheel at the National Night Out event at the fairgrounds. Big colorful things tend to catch the attention of children and there is a higher chance that they will approach and engage in conversation with Emerson and others with Safe Kids Minot. She is hoping to use the wheel at the fair again this summer. “Kids and adults love it,” Emerson said. During the COVID-19 pan-
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ABOVE: Amber Emerson with Safe Kids Minot stands in front of her board discussing playing safely and safety on-the-go. LEFT: Amber Emerson with Safe Kids Minot talks to a boy about the questions on the colored wheel at the North Dakota State Fair.
demic, Safe Kids Minot events through May have been canceled to abide by the recommendation of social distancing by Gov. Doug Burgum. Most of what Emerson does is community based, so not being able to get out into the community made it difficult for her to talk to parents and kids directly. To try to share some information about safety during the quarantine, Emerson updated the Safe Kids Minot page on Facebook. Some of the things she discussed were keeping the home safe by putting cleaning
products out of the reach of children to prevent poisoning, separating the older children’s toys away from the younger kids to avoid choking hazards and keeping button batteries away from kids, too. Putting small batteries in a safe location eliminates choking and poisoning hazards. Medications being up and out of reach is an additional factor she planned to discuss. As of March 25, Emerson said the Wild About Safety community day event later in the summer at the Roosevelt Park Zoo is still going to happen. Admission
to the event is free and different stations will be set up throughout the zoo and in parts of Roosevelt Park. Some of the topics include “water and fire safety, medication safety, farm safety and safety regarding car seats,” Emerson said, “just to name a few.” Every couple months, Emerson stops by nursing homes, as well, to go over health and safety tips for the residents. Making sure that children are safe worldwide is becoming more and more important as children have had to make visits to the emergency room and/or lost their lives for not wearing a helmet on a bicycle, getting into things they shouldn’t have, swallowing a small toy and many other things. Safe Kids Minot is here to serve the community and answer questions that parents and parents-to-be may have.
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Nurses
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and decided they could do the same. “So we got ahold of the right people and it just took off. It went quick. Luckily, the governor, with his Main Street Initiative, got his staff to support it, and I had a lot of people from the state reach out and say, ‘If you need any help, you let us know and we’ll make sure you get this done,’” Graeber said. Financially, hosting the nursing program has been reasonable, Graeber said. BSC splits the instructor cost if the program has more than five students and has landed grants to acquire the more expensive equipment. The Garrison hospital provides the classroom and skills lab. “It’s been pretty cost effective,” Graeber said. “We’re very excited about the program, and we’ve really thrown our support behind it because I think it’s a good way to get some homegrown people a good job and an opportunity to advance themselves.” The difficulty for many rural hospitals is finding an instructor, but Graebe said Garrison was fortunate in having Kishori Kelsey, a bachelor-degreed nurse at Turtle Lake, willing to take on the role. She is working toward her master’s degree. Staff nurses in the smaller, rural hospitals typically serve as part-time faculty for the programs. “They get to satisfy their love for teaching and still have that great patient-contact job, where they are working on the front lines,” Traynor said. A nurse holding a four-year bachelor degree can teach the clinical LPN program. To teach the RN course, a nurse must have a master’s degree. “With the Dakota Nursing Program, we are very strong with growing our own faculty,” Traynor said. “We started in 2004, and we are seeing now that the people who have been educated in the communities are now nurse practitioners in those communities. They have gone on to get their bachelor’s degrees and then their master’s degree. Some of them are teaching for us.” Medical facilities have been good partners in enabling nurses to teach while working and/or earning advanced degrees, she said. Traynor credits much the program’s success to the communities and their medical facilities. “If they just say ‘come in’ and then wash their hands of it, it’s not really going to be successful. There has to be community commitment and support,” she said.
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Saturday, April 4, 2020
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Minot Daily News • PROGRESS: Health Care
Working out benefits work Local companies support employee fitness
By JILL SCHRAMM
Senior Staff Writer jschramm@minotdailynews.com A healthier workforce is a more productive workforce, according to some local companies that are investing in their employees’ fitness. Minot Automotive Center and Hess Corp. are among companies that are giving employees incentives to get and stay fit. About eight years ago, Minot Automotive Center began offering a fitness reimbursement program. Any of the approximately 140 employees who participates at a local fitness center and brings in confirmation of having attended and exercised at least 12 times during the month is reimbursed with a $30 bonus on the next paycheck. Many employees who participate get hooked on the program and like it, said Kara Vetter, controller at Minot Automotive Center. “We’d like to see even more of them, but as far as the physical benefits, that’s pretty obvious. You have healthier people. That’s just good for everybody. It’s good for your health care costs and
then also just the mental benefits of having people just be happier and in better moods as they get some exercise,” she said. She estimated about 10% of employees participate, although it can vary seasonally. Employees can select the gym they wish to join. “We want to be as flexible as possible to get more people using it,” Vetter said. Minot Automotive instituted the program when its insurer started moving away from health incentive offerings because it was apparent employees liked and took advantage of the incentives. For some, it can be a key motivator to exercise. “If it’s going to keep them going, we didn’t want to lose it,” Vetter said. Hess uses a number of tools to encourage healthy habits among its employees. “The safety, health and wellbeing of our employees is something Hess takes very seriously. It doesn’t matter if the employee is sitting behind a desk in Houston, working on a pump jack in the Bakken oil fields, or driving a truck to bring Bakken oil to mar-
ket, we want all of our employees to be the best, healthy versions of themselves,” the company stated. Hess sponsors memberships to wellness centers, but it states one of the most successful ways it has introduced wellness to staff is through the use of technology and an app called Pulse (by Virgin). Through gentle reminders and notifications, Hess employees can track their good habits on the go, such as taking the stairs or achieving set number of steps in a day. Employees who use the app can check their daily progress at a glance and even can set important reminders like making doctors appointments or eye exams, according to the company. “Hess strives to use state-ofthe-art technology when it comes to producing and moving oil. But the same can also be said when it comes to motivating our employees to get moving,” said Hess General Manager Brent Lohnes in a prepared statement. “By encouraging healthy lifestyles through the use of the Pulse app, our employees create a fun culture and are more productive.” Once habits or daily goals
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MAIN: A cycling class is one of the fitness options available at the YMCA to employees who choose to take advantage of fitness club memberships through their employers. BOTTOM RIGHT: Getting people moving is the goal of Minot businesses that incentivize employees to use their local YMCA fitness centers. have been reached, app users receive points that can be shared among colleagues to see who leads in achieving their goals. The friendly competition creates engagement among employees from Minot to Houston and around the world to locations where Hess operates. Hess sees the app helping employees to adopt healthier lifestyles, which leads to more energy, focus and drive while at work. Walmart, another company with a presence in Minot, recently began offering employees
Make the choice to
protect your health. MyChoice Health Checks are low-cost screenings that make earlier detection and timelier care possible. You can choose which screenings you want and schedule quickly and easily with our imaging experts. MyChoice Health Checks help to identify risk factors that can lead to serious problems: • Heart attack Calcium Score Screening $60 • Stroke Carotid Artery Disease Screening $35 • Abdominal aneurysm Abdominal Aortic Aneurysm (AAA) Screening $35 • Painful legs and feet Peripheral Artery Disease (PAD) Screening $35 • Heart disease EKG $20 All screenings are read by board-certified radiologists and cardiologists. For appointments/questions, call 701-857-3220.
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nationwide discounted basic memberships in the gyms of their choice this year. The incentives lower employee out-of-pocket costs for membership to as low as $9 a paycheck (typically $18 a month). The Walton Life Fitness Pass offers access to as many as 9,000 facilities in the country. The pass is available to any employee at least 18 years old and includes a spouse or domestic partner. Dependents ages 18 to 25 also can participate. The program is open to full- and parttime employees, according to a release from the company.
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Saturday, April 4, 2020
Minot Daily News • PROGRESS: Health Care
Senior foot care By CIARA PARIZEK
RN Randall Hanson helps those in need
Staff Writer cparizek@minotdailynews.com Foot care is something that can be easily overlooked, but it is vital for the elderly. Randall Hanson from Minot stresses the importance of foot care and makes sure that around 300 elderly clients aged 60 and older have trimmed nails and healthy feet. Hanson worked for many years in the intensive care unit at Trinity Hospital before retiring in 2004. Then three years later in October, he started his foot care business after training with a podiatrist for a year. He is now a registered nurse (RN) and has contracts with assisted living and memory care facilities to care for the residents. House visits are also on his schedule on independent contracts for those who do not have easy access to transportation or have difficulty moving around. A person’s nails can cause many other problems if they are not properly maintained. Hanson described one gentleman who had such a bad ingrown toenail that it caused him immense pain. He couldn’t walk normally and had a limp. Limping for an extended period of time put his spine out of alignment, as well. Hanson referred the gen-
Randall Hanson posed for a photo in his clinic where he has done foot care for seniors. tleman to a podiatrist to have the ingrown toenail removed and he was back to walking normal again, his pain went away and he realigned his spine by seeing a chiropractor. To prevent that sort of situation, Hanson carefully trims and files their nails down by hand, making sure that he also smooths out any sharp edges. Nails
catching on the inside of their socks can make things uncomfortable and possibly cause pain. If there are any tight or sharp corners, he trims and files them. He gets one of his good quality files from Essex, England, and the other from St. Paul, Minn. He does not use any electric tools. Using electric tools can get hot on the per-
son’s foot and sanding down too far on a person’s foot that has diabetes can cause complications that he is not equipped to handle. When he begins with a client, he soaks their feet in warm water mixed with an ounce of Hibiclens scrub for 10 minutes. “It softens the nails and cleans the feet so that the germs are killed,” he said. He takes care of
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their nails and files down corns and calluses so they are flat. However, if they have corns or calluses that need to be cut down using a blade, he refers the client to a podiatrist so they can see someone who has expertise in that area. The same goes for clients that have red and swollen toes that look like they could be infected, and for clients with plantar
warts that need to be removed. “A person’s got to be very careful with the rules of how far you can go as an RN, even with specialty training,” he explained. “There’s only a certain amount you can do.” About half of his clients are diabetic, so they need foot care at least once a month. By seeing them every month or every other month, Hanson “reduces the possiblility of amputation by 85 percent.” There are many important reasons why foot care for people with diabetes is crucial. Diabetes can sometimes cause nerve damage and the individual may not have all of the feeling in their feet. That would make it difficult for them to know if there was something sharp in their shoe or even if they stepped on a shard of glass. The lack of bloodflow to the feet would make it a long and risk-filled recovery. The wound wouldn’t heal as quickly and that poses a higher risk of infection, in turn increasing the possibility of limb amputation. By helping his clients, Hanson is helping them stay healthy and keep their limbs. If footcare is needed, patients must be 60 years old or older. Appointments can be made with Hanson by calling Minot Commission on Aging at 701-852-0561.
Benefiting from opportunities “But if you have clinical settings where they know that you can push yourself harder, they’re going to make sure that your training is the best training out there.”
Nurse practitioner achieves goals by educational steps By JILL SCHRAMM
Senior Staff Writer jschramm@minotdailynews.com One step led to another for Minot’s Danna Bossert, whose educational path to become a nurse practitioner was paved with the help of nontraditional options and a supportive employer. Bossert has practiced family medicine as a nurse practitioner at Sanford Health’s Northwest Clinic in Minot since October 2019. She has been with Sanford, advancing her education, for almost nine years. “I cannot say enough good things about Sanford,” she said. “When I told them that I wanted to go back to school, they not only were accommodating, they essentially pushed me to it and said, ‘This is what we look for in our nurses. We want our nurses to be able to grow within our system.’” A graduate of Bishop Ryan High School in Minot, she worked at Roosevelt Park Zoo from her teen years until the flood of 2011, which prompted her move to Bismarck after the family home was damaged. Before leaving Minot, she completed most of her training as a certified nursing assistant at Trinity Health through the Dakota Nursing Program and Williston State College. She had
worked as a CNA at The Wellington, a Minot assisted-living center. Her interest in health care had been sparked when her father almost died from a stroke when she was a senior in high school. She and a brother were the only ones to aid their father until medical help was available, and it impressed on both of them the importance of knowing how to respond. Once she became a CNA, she began considering advancing her education to become a licensed practical nurse. The Dakota Nursing Program provided the ideal option for training. She worked as an LPN from 2011 to 2013 before enrolling at the University of Mary to become a registered nurse. As an LPN she worked in a long-term acute care program and later in a walk-in, acute care setting at Sanford Health in Bismarck, where she was living at the time. It was the motivation provided by her Sanford boss, Jeff Klop, that prompted her decision to advance her skills as an RN. Sanford provided her the clinical setting needed in her training. Bossert said the opportunities presented her at Sanford put her in the best possible positions as a nurse. Picking up overtime hours by filling shifts at various clinics on her days off as an LPN, she ended up in Sanford’s
– Danna Bossert, FNP, Sanford Health
internal medicine department, working with internal medicine nephrologist Dr. Michael LeBeau, now Sanford’s CEO in Bismarck. After graduating from the University of Mary, she joined the department as a special procedures RN. She worked there for about three years. Becoming a nurse practitioner was always in the back of her mind, she said. However, she credits her exposure to team-based care under LeBeau and nurse practitioner Sally Frank to providing the impetus. Bossert explained she was able to see the autonomy a nurse practitioner can have and gain the encouragement to take that latest step in her education. She did so by enrolling in Maryville State University in St. Louis, Mo. Training was online, and Bossert completed clinicals with Sanford. “They were super accommodating. I had clinicals at my fingertips at all times,” she said of Sanford. “Even
state programs struggle to find clinical settings for people, and not one second did I doubt that I would find clinical spots.” Becoming a clinical nurse practitioner is really all about the clinical training, Bossert said. Sanford pushed her during her clinical training and never backed off. “I was thrown into the fire essentially. They knew me as a nurse. They knew what my scope of practice was and they also knew my potential,” she said. “They kept essentially the foot on the gas the whole time and pushed me to learn. It’s definitely one of those degrees where, if you’re not willing to put in an effort, you’re not going to get as good of an education. But if you have clinical settings where they know that you can push yourself harder, they’re going to make sure that your training is the best training out there.” Sanford also offers a nursing loan
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program to assist with the financial side of education. Bossert said she was able to continue working while training, although her work became parttime toward the end due to the rigor of the clinicals. Bossert had returned to Minot and was able to do a majority of her clinical training at Sanford’s family practice clinic in Minot. Now practicing in Minot, Bossert provides a variety of care in the family practice setting. “It’s been nice to come home and be able to now give back to this community,” she said. She also finds she enjoys family practice more than she ever thought she would. “I love the patients, I love the connections that you get to make with patients. You get to do that as a nurse, but it’s just not on the same level. There’s something about people trusting you with their health care and coming to you and wanting to form that connection that I thrive off,” Bossert said. “Being able to really fully understand their health care and wanting to be able to work with them to make sure we’re getting their quality of life where it should be while still maintaining their health is like a rush for me.” Bossert hasn’t set any new goals yet but ideas are starting to formulate. “I do think down the road that educating nurses is something that I would be very interested in,” she said. “What a cool job to get to teach other nurses what you already know in this skill set. That definitely is calling my name at some point.”
Saturday, April 4, 2020
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Minot Daily News • PROGRESS: Health Care
Mental health advances By CIARA PARIZEK
Transcranial magnetic stimulation therapy
Staff Writer cparizek@minotdailynews.com Depression affects the lives of millions of people in the United States, and millions more around the world. It can be extremely difficult to live with the gray cloud hovering above one’s head every day. Trinity Health Center Riverside offers transcranial magnetic stimulation (TMS) which has helped make the lives of about 75,000 people better. TMS in a non-invasive method of therapy, sending electromagnetic pulses through the patient’s brain via electromagnetic coils that are strategically placed. The pulses target the parts of the brain that are underactive and don’t do their job successfully. The pulses that are used are usually at a fast and high frequency to improve functionality of those areas. The doctor administering the TMS uses brain mapping during the first appointment to assure that the coils are placed where they will be the most effective. One interesting fact about the TMS equipment is that it knows when a coil isn’t in its proper place. It beeps at the doctor and tells them which one needs to be redone. Psychiatrist Linda Carpenter was quoted in a story by Stacey Colino, saying that TMS helps the brain “run curcuits more efficiently, make new neural connections, and restore neural rhythms.” Carpenter is also a research professor of psychiatry and human behavior at Brown University and director of the Butler Hospital TMS Clinic and Neromodulation Research Facility in Providence, R.I. “There may be some other effects, too, she says, such as improving blood flow and the functioning of the cells’ mitochondria - their energy producrers,” Colino added from Carpenter. One of the common myths about TMS is that it’s
Submitted Photo
Kiley Andreas, PMHCNS-BC, a Psychiatric-Mental Health clinical nurse specialist, is shown with Trinity Health’s Transcranial Magnetic Stimulation system, a treatment option for patients with resistant depression. the same as electroconvulsive therapy (ECT). They are, in fact, very different. ECT requires the patient to be put under anesthesia while electrical currents are sent through the brain. Using the electrical current, Tonya Anderson, a nurse practitionaor at Trinity Riverside, described ECT as “intentionally giving the patient a seizure.” Some of the side effects that come with ECT are nausea, confusion and memory loss. TMS does not have any of those side effects. The only thing that patients who receive TMS experience is mild to moderate pain at or near the treatment sites. That pain typically goes away after the first week of sessions. During their sessions, the patient stays awake and alert, watching a movie or show, or even
reading a book, if they so choose. The process of receiving TMS therapy is very thorough, only available by prescription. For those with Blue Cross Blue Shield or Medicare health insurance, the patient would have to have tried at least four antidepressants that did not work for them, go through at least two types of augmentation therapies and get a preauthorization from their insurance. The first person they would have to talk to is their primary care provider to see if TMS would be the best method of treatment for them. NeuroStar Advanced Therapy also accepts many other commercial and government insurances, including Tricare. However, Medicaid is not included in that list.
If they receive the prescription, the patient can go to the nearest TMS provider. One of the first steps in the process is filling out a patient healthcare questionnaire for depression. If their score is 20 or above, they qualify for TMS. However, if their score is under 20, they are not eligible. Patients who qualify will typically have a total of 36 sessions, spread out over nine weeks. For the first six weeks, they must do five sessions per week. During the seventh week, they must do three sessions. Week eight consists of two sessions, and week nine is only one ses-
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sion. In the case where an individual’s doctor may deem it necessary, they will do more or less than the usual 36 sessions. In order for the treatment to be effective and for insurance to continue covering it, the patient must attend their sessions. In some extenuating circumstances, like if they are sick, rescheduling a few appointments will not affect their eligibility. However, if they miss too many, insurance will no longer cover it, so that is something to be mindful of. Trinity Riverside is the only facility in the state of North Dakota that offers tran-
scranial magnetic stimulation through NeuroStar Advanced Therapy. Anderson said that at the moment, only Major Despressive Disorder (MDD) is covered by insurance. She also said that TMS has saved lives. Those who were struggling with their depression and suicidal thoughts or tendancies that underwent TMS saw an improvement in their mental health. Some research is being done to see what effects TMS would have on helping indiviuals with Attention Deficit/Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD) and those that are on the Autism spectrum. Trials have been done for individuals that have Parkinson’s Disease and stroke patients. TMS showed promise by easing the patients’ problems with movement. One woman from Ohio had a stroke in 2013 and she underwent TMS. After just six sessions, she retained enough of her fine motor skills that she could pick up BBs. TMS could also help alleviate Post-Traumatic Stress Disorder (PTSD), anxiety and chronic pain. While depression and PTSD are targeted on the left side of the brain, anxiety is targeted on the right side. The electromagentic pulses that are used for PTSD, anxiety and chronic pain are at a lower frequency to slow activity. Transcranial magnetic stimulation has a wide variety of uses and can help in all sorts of ways, especially mental illness. MDD is something to be taken seriously and it’s a good thing that steps are being taken to help those that desperately need it. Those who have questions about TMS should contact their primary care provider.
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Minot Daily News • PROGRESS: Health Care
Visit us online at www.MinotDailyNews.com
Saturday, April 4, 2020