Baxter Regional
SPRING 2022 VOLUME 5 | ISSUE 2
FIGHTING PARKINSON’S ROCK STEADY BOXING GROWING NEW HEROES NURSE RESIDENCY PROGRAMS
PEDIATRICIAN
SHAYNA
WOOD, MD Medicine is Her Ministry
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Table of Contents
50 44
38
FEATURES
32 | Bless the Child Pediatrician Shayna Wood, MD, feels like medicine is a ministry and was called to help others.
38 | Growing New Heroes Baxter Regional Residency Programs give nurses a head start.
44 | The Future is Now Mazor Robot laser debuts in neurosurgery department.
50 | Rock Steady Boxers Fighting Parkinson’s disease with exercise and determination.
DEPARTMENTS 08 Letter from the President & CEO 12 Healthcare Happenings 16 Community Houses 20 Baxter Regional Hospital Foundation 24 Baxter Regional Clinics 28 Baxter Regional Board Member 56 Wellness
On the cover: Dr. Shayna Wood at Baxter Regional Med-Peds Clinic. Photography by Jason Masters.
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60 Nutrition 64 Chaplain’s Corner
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Baxter Regional
A PUBLICATION OF BAXTER REGIONAL MEDICAL CENTER
Come and Enjoy Life in the Ozarks
624 Hospital Drive, Mtn. Home, AR 72653 870-508-1000 baxterregional.org
SPRING 2022
VOLUME 5 | ISSUE 2 BAXTER REGIONAL SENIOR LEADERSHIP TEAM
Kriss Yunker 870-404-6875
kriss@peglarrealestate.com 1326 Hwy 62 E Mtn. Home, AR 72653
President/Chief Executive Officer Ron Peterson VP/Business Development and Executive Director, Baxter Regional Hospital Foundation Barney Larry VP/Chief Financial Officer Debbie Henry VP/Chief Nursing Officer Shannon Nachtigal, MSN, RN, NEA-BC VP/Human Resources Karen Adams VP/General Counsel Nicole Vaccarella VP/Physician Enterprise Bill Baldwin
PULSE EDITORIAL
Family Practice and Internal Medicine since 1978 At Lincoln Paden Medical Group, you and your entire family will be cared for in a safe and friendly environment by our family of experienced physicians, nurse practitioners, nurses, and dedicated office team. Our services include family practice, internal medicine, men's health, women's health and chronic care management. We are accepting new patients, and in addition to customary in-office visits, we offer telemedicine, virtual and drive up car visits. Please call for an appointment today.
405 Buttercup Drive Mtn. Home, AR (870)425-3030 www.lincolnpadenmedicalgroup.com
Now accepting new patients!! 6
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Executive Editor Tobias Pugsley Associate Editor Adrienne Koehn Contributing Writers Dwain Hebda and Deborah Stanuch Contributing Copy Editor Melinda Lanigan Contributing Photographer Jason Masters, James Moore and James Stefiuk Contributing Designer Ashlee Nobel
PUBLISHED BY
WHEELHOUSE PUBLISHING
501-766-0859 WheelhousePublishing.com
The Baxter Regional Pulse magazine is distributed quarterly to Baxter Regional Hospital Foundation donors with the remaining copies distributed in the hospital’s 19 clinics, community support houses and locations within our twostate, 11-county service area. To advertise call 501-766-0859 or email sarah@wheelhousepublishing.com. Baxter Regional complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-870-508-7770. CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-1-870-508-7770.
Neurosurgery, close to home.
(870) 508-7080 www.baxterregional.org
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Letter from the President & CEO
STRIVING FOR EXCELLENCE
Thanks,
“Excellence is the gradual result of always striving to do better.”
~Pat Riley, NBA Hall of Fame Coach
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RON PETERSON President/Chief Executive Officer Baxter Regional Medical Center
PHOTO: COURTESY OF BAXTER REGIONAL
THE PURSUIT OF EXCELLENCE AT BAXTER REGIONAL SHOWS. We are not satisfied with the status quo; we pursue new technologies, expand healthcare in the community and seek ways to attract and retain talent to our facility. All of this effort is who we are, and excellence in quality patient care is the outcome. Our patients’ care and comfort are our priority. Because of this commitment, Baxter Regional has been named to the Top 100 Rural and Community Hospitals list, and we thank all our staff and volunteers for all you do each and every day. Equally as important as patient care is our institution’s care and mentoring of its staff. This is why Baxter Regional has two new nursing residency programs targeting LPNs and nursing assistants. They join the successful registered nurse residency program in existence since 2013. Success is helped by the simulation lab, which provides medical manikins for nursing residents to practice on, as well as our preceptor program in which experienced nurses serve as real-world, real-time mentors to the newcomers. In this issue, you’ll learn of another exciting development — the new Mazor Robot, which helps in navigational surgeries, particularly of the brain and spine. It’s rare for a hospital of Baxter Regional’s size to have this technology, so the “investment in this technology and training is huge,” according to Dr. Allan Gocio, a neurosurgeon at Baxter Regional. We also feature the newest pediatrician at Baxter Regional, Dr. Shayna Wood, who moved to Mountain Home with her family in July, 2021. And we profile Tony Wright, a certified pharmacy technician at Baxter Regional, who realized a successful fitness journey depended on finding his own motivation to make positive, healthy life changes. Along with this, we focus on the inspiring women of the Rock Steady Boxing program, which aims to slow the progression of Parkinson’s disease. Find programs like this and more in our Community Houses section of Pulse Magazine. We have accomplished so much in the last few years: Magnet® status, recognition in the Top 100 Rural and Community Hospitals, the addition of new nursing residency programs and the expansion of satellite offices to better serve our community — all of this while battling multiple variants of COVID-19. Caring for our patients and caring for our community is who we are. It is our commitment to excellence in all that we do that drives us, each and every day.
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Contributors
Ashlee Nobel
GRAPHIC DESIGNER Ashlee Nobel is a graphic designer and illustrator with a background in publication design. After working her way up to Creative Director over two magazines in Little Rock, she set out on her own to freelance and focus on her art, creating Lee Lee Arts + Design. When she’s not drawing or designing she enjoys gardening, biking and reading.
James Moore
PHOTOGRAPHER James Moore is a photographer and filmmaker located in North Central Arkansas. For over 20 years, he has used his talents in the marketing sector, creating content and building brands for local and national companies across a broad spectrum of industries. He has three amazing sons and a beautiful wife.
Melinda Lanigan
COPY EDITOR Melinda Lanigan is married with six daughters and is a Florida native. She has worked in the publishing industry since 1995 as a copy editor, writer, production director, and in project and distribution management. When she's not deconstructing sentences, she is singing and playing guitar and keyboard with her band, The Allie Cats, in Tallahassee, Florida. She also enjoys spending time with her fur baby rescues — three dogs, five cats and a horse named Maggie.
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BAXTER REGIONAL HEALTHCARE HAPPENINGS MILESTONES, NEWS AND SPECIAL EVENTS AT BAXTER REGIONAL
JAKE LONG
GRACE
CROWNOVER
LONG AND CROWNOVER JOIN BAXTER HOSPITAL FOUNDATION BOARD Barney Larry, Executive Director, Baxter Regional Hospital Foundation and Vice President/Business Development, Baxter Regional, has announced Dr. Jake Long and Grace Crownover have joined the Hospital Foundation Board of Directors. Dr. Long is Superintendent of Mountain Home Public Schools, and Grace Crownover is Office Administrator of Crownover Companies.
BAXTER REGIONAL NAMED TO 2022 TOP 100 RURAL AND COMMUNITY HOSPITALS LIST “It was a complete surprise,” said Ron Peterson, Baxter Regional President/CEO when he learned the hospital was recognized as one of the 2022 Top Rural and Community Hospitals in the country. “This was not something we applied for or were aware we were being considered for. It’s a very pleasant surprise.” “We are delighted to recognize the exceptional
performance and innovation of this year’s recipients, particularly in light of the extraordinary challenges facing America’s rural health safety net,” said Michael Topchick, national leader of the Chartis Center for Rural Health said. “Despite unprecedented adversity, rural providers continue to display resiliency and a steadfast commitment to their communities.”
“It’s always nice to receive recognition for the things we do on a daily basis. We work hard to embody our mission to provide excellent care to every patient, every time. The honor is a true reflection of our physicians, volunteers and staff and the quality of everybody involved in helping us be the very best we can be,” said Peterson.
LEARNING SESSIONS FROM COMMUNITY HEALTH EDUCATION AND LEARNING HOUSES GO MOBILE Diahanne VanGulick, Mruk Family Center on Aging Coordinator, and Jodi Bodenhamer, Coordinator at the Reppell Diabetes Learning Center, have announced learning sessions on nutrition, selfcare skills, healthy living, dementia and transitional living for seniors are available at locations
throughout the Baxter Regional service area. To request information on scheduling a learning session at a church group or other organization, contact VanGulick at 870-508-3881 or Bodenhamer at 870-508-1765.
ROCK THE BARN FOR THE MRUK FAMILY EDUCATION CENTER ON AGING After two postponements due to the COVID-19 pandemic, the Mruk Family Education Center on Aging held what should have been their 7th annual Rock the Barn fundraiser on Saturday, April 23, at the Wellness Education Center located at 2545 Highway 5 North in Mountain Home. The event featured music by the Kattie Laney Project Band, a barbecue dinner, silent auction, cake walk and exhibits highlighting MFECOA programs. Diahanne VanGulick, Mruk Family Education Center on Aging Coordinator, says the next Rock the Barn will be held in the spring of 2023 at a date to be determined in the fall of this year. FOR INFORMATION, CALL 870-508-3880.
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BAXTER REGIONAL KEY ACCOMPLISHMENTS IN 2021 Ron Peterson, Baxter Regional President/CEO, has released the hospital’s annual list of Key Accomplishments. Peterson said it was “amazing” as he reflected on Baxter Regional’s 66 Key Accomplishments of 2021. “Considering we were dealing with two variants of the COVID-19 virus and other challenges, it is truly amazing. This was a team effort, and these accomplishments speak volumes about the dedication of our staff, organization and supportive community to our hospital.”
1.
22. Set record for most episodes of care
OPENED OUTPATIENT SURGERY CENTER.
2. Achieved Magnet Designation. 3. Successfully completed first TAVR procedure. 4. Patient Experience – Inpatient Overall Rating increased 3.3%.
5. Named Modern Healthcare Best Places to Work. 6. Named Arkansas Business Best Places to
Work (third year in a row). 7. Added a Vascular Access Team for patient care. 8. Set record for organization’s largest gross and net revenue (volume indicator). 9. Renovation of 5 South began, adding six new rooms. 10. Foundation raised over $1.2 million for 5 South remodel from the community. 11. Hiram Shaddox property purchased and cleared. 12. Built new 11,000-square-foot loading dock. 13. Level III Trauma redesignation with NO deficiencies.
15. Earned Medicaid Inpatient Quality Award. 16. Avoided the Hospital Acquired Conditions (HAC) penalty.
17. Patient Experience – Emergency Department overall rating increased 1%.
18. Set hospital record for most acute care inpatient days at 33,892.
19. Expanded the size of OR #5. 20. Added 11 new physicians. 21. Added five clinics to Baxter Regional. 14
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(patients) in Home Health at 3,065.
23. Received $2.5 million in gifts from the
“This was a team community to the Foundation. effort, and these 24. Opened Ed and Gayle Goodman accomplishments Simulation Center. speak volumes 25. Opened food market through Employee about the Concierge Services. dedication of our 26. Added negative pressure rooms to all of 2 staff, organization West, 2 South, ER, Rehab, WNCC, OR #11 and and supportive ICU for COVID-19 patients. 27. Started central sterile expansion/remodel. community to our 28. Improved physician enterprise revenue cycle. hospital.” 29. Provided over 25,000 doses of the Ron Peterson, COVID-19 vaccine. Baxter Regional CEO/President 30. Patient Experience – Outpatient Therapy maintained a raw score over the goal of 89.2%. 31. New record: It now costs over $750,000 a day to operate Baxter Regional. 32. Received two Diamond Awards for marketing materials. 33. Increased gross revenue by 10% PROVIDED MONOCLONAL over 2020. ANTIBODIES FOR OVER 1,600 34. New monthly record COVID-19 POSITIVE PATIENTS. set in December with 832 surgeries.
35.
36. Provided care for
over 1,000 COVID-19 inpatients. 37. Started a master facility plan for longterm growth and campus design. 38. Started weekend hospitalist coverage for Fulton County Hospital.
14.
BROKE GROUND FOR A NEW 33,0000-SQUARE-FOOT CANCER CENTER.
39. New record for Pulmonology Clinic with 14,550 patient visits.
40. Patient Experience – Physician Clinic overall rating increased 3.9%.
41. New Record – over 23,000 CT procedures performed.
42. Recovered from Kronos cyber security break. 43. Successfully managed COVID-19 funds. 44. A/R management/revenue cycle record months with 32 days in A/R.
45. Provided $600,000 in scholarships to employees for education expenses.
46. Opened two physical therapy clinics — Melbourne and Hardy.
47. ACO gained shared savings from MSSP Plan. 48. Created a full-time RN recruiter position. 49. Onboarded 38 RN residents. 50. New record for Oncology Clinic with 17,799
patient visits. 51. New record for Infectious Diseases Clinic with 8,811 patient visits. 52. 13 clinic moves/expansions or remodels in 2021. 53. Added new call light system to five different units in the hospital. 54. Achieved 1,230 days of PPE supplies in hospital inventory for emergencies/shortages. 55. Established centralized and electronic credentialing process for medical staff. 56. Added communication to patient family members via texting in surgery. 57. Patient Experience – Outpatient Services overall rating increased 6.3%. 58. Redesigned ER waiting area to accommodate COVID-19 patients. 59. Discharge planning team made over 10,000 patient visits. 60. Recovered over $750,000 through denials and appeals work. 61. Deployment of audio/visual systems to seven locations throughout the organization. 62. Implemented two-factor authentication for prescribing narcotics (Patient Safety). 63. Exceeded Baxter Regional Strong goals for 2021 cost savings. 64. Purchased new monitors for all ER rooms. 65. Patient Experience – Outpatient Surgery overall rating increased 5.7%. 66. New record for hospital outpatient visits at 160,316.
MAGNET CELEBRATION Baxter Regional will celebrate the achievement of Magnet Recognition Friday, May 6, from 5–9 p.m. at Hickory Park in Mountain Home. There is no admission charge for the event, which includes live music by Members Only, food trucks, craft vendors, kids zone and beer garden. The public is encouraged to join the hospital physicians, nurses, volunteers and staff in the celebration of achieving Magnet Recognition which was announced in June of 2021. Last year’s planned celebration was
+
postponed due to the uncertainty of the COVID-19 pandemic. Only five hospitals in Arkansas are among the 545 hospitals in the country who have achieved Magnet status, considered the highest credential for nursing facilities in the U.S. and the world.
HOSPITAL NURSES WEEK
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May 2–6 - A weeklong series of events honoring Baxter Regional nurses who work so hard every day taking care of all patients, especially during the COVID-19 pandemic. Monday - Shared Governance Day, a fun day with treats and prizes for attendees planned by the Shared Governance Chairs and Co-Chairs.
Tuesday - Spa Day, a day of rest and relaxation with massages, a coffee bar and more.
Wednesday - Nurse Leader Day, a day when nurse leaders recognize and show appreciation for their nurses.
Thursday - Baxter Choice Day, a day to recognize nursing staff members who have been nominated for their outstanding performance.
Friday - Magnet Celebration, a celebration of achieving Magnet Recognition.
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BAXTER REGIONAL COMMUNITY HOUSES ARE OPEN HOURS: Weekdays 9 a.m. to 4 p.m.
Masks and social distancing required per Baxter Regional COVID-19 protocols, including checking temperatures and screening at the door. For additional information, visit www.baxterregional.org or call the individual house.
MRUK FAMILY EDUCATION CENTER ON AGING 870-508-3880 All sessions are at the Mruk Family Education Center on Aging unless otherwise noted. Due to COVID-19, class capacity is limited. Masks are required to attend all our programs. Pre-registration is required for all programs. Call 870-508-3880.
For information regarding closings or cancellations of Mruk Family Education Center on Aging programs, visit www.ktlo. com/cancellations or follow Mruk Family Education Center on Aging on Facebook. CALENDAR:
SUPPORT SERVICES
Better Breather’s Support – Second Friday at 2 p.m. (Please call to verify.)
Parkinson’s Family Caregiver Support – Second Thursday at 10:30 a.m. (Location changes, please call for more information.)
Dementia Family Caregiver Support Group – Fourth Thursday at 1:30 p.m.
Registration and assessment required. Call 870-508-3880.
DEMENTIA THURSDAYS MAY: 5th Early to mid-stage dementia, 1:30–2:30 p.m. 12th Mid to late stages of dementia, 1:30–2:30 p.m. 19th Brain changes related to dementia, 1:30–2:30 p.m. 26th Dementia caregiver support group, 1:30–2:30 p.m. JUNE: 2nd Workshop A: Normal/not normal aging, 1:30–3:30 p.m. 9th Workshop B: Positive physical approach, 1:30–3:30 p.m. 16th Encouraging mobility & activity in dementia, 1:30–3:00 p.m. 23rd Dementia caregiver support group, 1:30–2:30 p.m. 30th Transitioning living & care in dementia, 1:30–3:00 p.m.
– May 10 at 6 p.m.
JULY: 7th Dementia 101: Understanding the changing brain in dementia vs. normal aging 14th Anticipatory grief in dementia 21st Creating a dementia-friendly home 28th Support group
SENIOR EXERCISE
JOURNEY TO HEALTHY AGING
Dementia Workshops & Support –
Every Thursday. Check schedule for topics and times.
Grandparents Raising Grandchildren
Fit & Fab for Women, Strengthening and Balance – Tuesday & Thursday, 9:15 a.m. or 10:15 a.m.
Fitness for Men, Strengthening and Balance – Monday, Wednesday & Friday at 9:15 a.m.
Registration required for men’s and women’s classes held at the Wellness Education Center at 2545 Hwy 5 North, Mountain Home. Social distancing at 12 feet so masks can be removed just during exercise. No charge, but monthly or one-time donations appreciated. Call 870-508-3880.
Rock Steady Exercises for individuals diagnosed with Parkinson’s disease – Monday, Wednesday, Friday. Times vary.
MAY:
GO WHOLE FOOD, PLANT-BASED: Snacks & Desserts with Rick Calvaire, RN, co-owner of Tree of Life – Monday 9th, 5–6:00 p.m.
GRANDPARENTS RAISING GRANDCHILDREN, Cooking Matters at the Store Tour – Tuesday, 10th at
Jason Smith, DPT Baxter Regional Physical Therapy – Tuesday, 24th from 1–2:00 p.m.
JUNE:
GO WHOLE FOOD, PLANT-BASED: Spices & Herbs with Rick Calvaire, RN, co-owner of Tree of Life – Monday, 13th from 5–6:00 p.m.
CHRONIC COUGH: Causes & Treatments with Casey Drennin, Speech-Language Pathologist North Arkansas Speech Services – Tuesday, 14th from 1–2:00 p.m.
DISHING UP SENIOR NUTRITION: Diet/Lifestyle with Jodi Bodenhamer RN, Diabetes Educator – Wednesday, 15th from 3–4:00 p.m.
AARP DRIVER SAFETY While we are feeling a little more optimistic that we will soon be able to offer an inperson class, AARP Driver Safety continues to be suspended until further notice. We will continue to add names to our call list for when we are able to meet in person again. To be added to the list, call 870-508-3880.
PEITZ CANCER SUPPORT HOUSE 870-508-2273 CALENDAR:
Personalized Information and Support – Available anytime during business hours. Also available after hours by appointment.
Recently Diagnosed Information and Support – Every Wednesday at 1 p.m. Grief Support – Monthly, First Thursday
6:00 p.m.
at 1 p.m.
DISHING UP SENIOR NUTRITION, Natural Things You Can Do to Improve Your Health with Tamara Carl –
Ostomy Information and Support –
www.wholegrain100.com. Wednesday, 18th from 3–4:00 p.m.
VERTIGO: Causes & Treatments with
Monthly, First Friday at 11 a.m.
Men’s Cancer Discussions – Monthly, Second Thursday at 9 a.m.
Caregivers Information and Support – Monthly, Third Thursday at 1 p.m.
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BAXTER REGIONAL COMMUNITY HOUSES CONTINUED Strive and Thrive by Heather Hammonds, MD, CAQSM, dipABLM –
and Thursdays 3rd, 10th, 17th, 24th, 31st. Requires a physician’s referral. Call 870508-1765 for times and registration.
Novel Women’s Book Club – Third
Threads of Hope: Creating Gifts for Cancer Patients – Every Monday at 1 p.m.
Healthy Nutrition Workshop: Mediterranean with Jan Halligan, RD, LD, CDCES – Wednesday, 15th from
and third Thursday of every month, 1 p.m.
Monthly, Third Wednesday at 3 p.m.
Walking to Thrive – Every Monday at 9 a.m. Knock Out Cancer Boxing – Every Tuesday & Thursday at 3:30 p.m.
Intermediate Yoga – Every Tuesday &
Noon–1 p.m. at Wellness Education Center at 2545 Hwy. 5 North, Mountain Home.
Type 1 Diabetes Kids Summer Outing
Thursday at 8 a.m.
– TBA. Please call 870-508-1766 for more details.
Chair Yoga – Every Monday & Friday at
JULY:
10 a.m.
Nicotine Cessation with Roxy Koop – Scheduled by appointment only.
MAY
Lunch & Learn: Skin Cancer Awareness by Mark Hammonds MD, Dermatologist – Tuesday, 10th at Noon JUNE
Cancer Survivors Painting Class by Roxy Koop – Friday, 10th at 1 p.m.
REPPELL DIABETES LEARNING CENTER
870-508-1765 Open Monday–Friday 9 a.m.–4 p.m., walkins welcome. After hours by appointment only. Free diabetes testing kits and insulin supplies for anyone in need, no prescription needed. CALENDAR:
MAY:
Diabetes Self-Management Classes
– Tuesdays: 3rd, 10th, 17th, 24th, 31st; Wednesday: 4th, 25th and Thursday 5th, 12th, 19th, 26th. Requires a physician’s referral. Call 870-508-1765 for times and registration.
Healthy Nutrition Workshop: Vegetarian/Flexitarian with Jan Halligan, RD, LD, CDCES – Wednesday, 18th from Noon–1 p.m. at Wellness Education Center at 2545 Hwy. 5 North, Mountain Home.
Type 2 Diabetes Support Group Meeting – 20th, 11 a.m.–Noon JUNE:
Diabetes Self-Management Classes – Tuesdays: 1st, 8th, 15th, 22nd, 29th
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Diabetes Self-Management Classes – Tuesdays: 5th, 12th, 19th, 26th and Thursdays: 7th, 14th, 21st, 28th.
Requires a physician’s referral. Call 870508-1765 for times and registration.
Diabetes Caregiver Support Group – Friday, 15th from 10 a.m.–Noon at Reppell Diabetes Learning Center.
Healthy Nutrition Workshop –
Wednesday of the month, 1 p.m.
Mommy & Me Support Group – First Fibromyalgia Support Group – Monthly, second Monday, 10 a.m.–12 p.m.
Breastfeeding Support & Tips for Successful Nursing – Drop-ins are every Tuesday, 12:30 p.m.–2:30 p.m.
EXERCISE: Held at the Wellness Education Center at 2545 Hwy. 5 North, Mountain Home. Line Dancing – Every Tuesday, Beginners at 11:15 a.m. and Advanced at 12:15 p.m.
Dance! – Every Monday & Wednesday, 4:15 p.m.
Cardio Kickboxing & Strength Training with Angie Bertel – Every Monday & Wednesday, 5:30 p.m.
MAY:
Wednesday, 20th from 11:30 a.m.–1 p.m. at Wellness Education Center at 2545 Hwy. 5 North, Mountain Home.
Patio Meet & Greet: Tea with Mom & Me – A day to celebrate the mom or mom
Healthy Nutrition Workshop: Active Snacks with Jan Halligan, RD, LD, CDECS – Wednesday, 20th from Noon–1
Women’s Health Forum: Celebrating Women! – Featuring a medical panel,
p.m. at Wellness Education Center at 2545 Hwy. 5 North, Mountain Home.
SCHLIEMANN CENTER FOR WOMEN’S HEALTH EDUCATION
870-508-2345 Limited seating, reservations required. CALENDAR:
PRENATAL CLASSES: Childbirth Class – Second Saturday of every month, 9 a.m.
Breastfeeding Class – Third Tuesday of every month, 5:30 p.m.
figure in your life. Tuesday, 3rd at 11 a.m.
keynote speakers and a Q&A session of our panelists. Thursday, 19th at 9 a.m.
Learning Session: Healthy Aging, Normal vs. Not Normal with Jessica Johnson, APRN, Fairlamb Senior Health Clinic – Friday, 27th at 12:30 p.m. JUNE:
Learning Session: Pelvic Floor Therapy with Renee Rodgers, PT, MS, CLT, Baxter Regional Clinic Yellville – Tuesday, 14th at Noon
Learning Session: Into the Light, Human Trafficking – Tuesday, 28th at 11 a.m.
Safe Sitter ® – Wednesday, 8th &
Thursday, 9th at 9 a.m. and Wednesday, 22nd & Thursday, 23rd at 9 a.m.
Getting Creative Summer Workshop –
SUPPORT GROUPS:
Every Friday from 10 a.m.–12 p.m.
Infant Loss & Support, Facilitated by Deanna Howarth-Reynolds, LMFT, Lighthouse Counseling Of the Ozarks
JULY:
– First Thursday of every month, 5:30 p.m.
Thursday, 7th at 9 a.m. and Wednesday, 20th & Thursday, 21st at 9 a.m.
Heart Healthy Women – Second
Getting Creative Summer Workshop –
Thursday of every month, 1 p.m.
Safe Sitter ® – Wednesday, 6th &
Every Friday from 10–11 a.m. n
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Baxter Regional Hospital Foundation
A graduate of Mountain Home High School, Edwards graduated from the University of Arkansas in Fayetteville with a Bachelor of Science in business administration and a Master of Science in operations management. She and her husband Dylan, who also graduated from Mountain Home High School and the University of Arkansas, reside in Mountain Home with their son and daughter.
BAXTER REGIONAL PULSE Sarah |Edwards 20
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PHOTOGRAPHY BY JAMES MOORE
FOUNDATION SPOTLIGHT:
Sarah Edwards MAJOR GIFT OFFICER BY DEBORAH STANUCH IN 2021, SARAH EDWARDS JOINED THE BAXTER REGIONAL HOSPITAL FOUNDATION AS MAJOR GIFT OFFICER. In this role, Sarah leads the foundation's major gift effort, a vital component for our hospital to stay independent according to Barney Larry, Foundation Executive Director and Baxter Regional Vice President/Business Development. The funds from major gift efforts add additional services and equipment not supported by the hospital's annual budget. “Sarah is the right person to lead this important funding effort. Her five years of experience as a Physician Recruiter and Director of Business Development have made her a great resource for individuals who have a passion and desire to support the Baxter Regional mission,” said Larry. “My previous roles at Baxter Regional allowed me to build relationships with our medical staff and members of the community to be effective in the role of Major Gift Officer,” said Edwards. “I’ve learned how important our hospital is to the community and surrounding region. The funds we raise allow our hospital to keep growing and providing the latest technology and equipment needed to fulfill our mission ‘to provide excellent patient care to every patient, every time.’” As Major Gift Officer, Edwards will work closely with John Dyess, chairman of the Major Gift Committee. The owner and president of Altronic Research Inc. in Yellville, Dyess joined the
Hospital Foundation Board in 2007. As major gift chairman, he has been involved in the renovation of the 2 West, 3 West, Women & Newborn Care Center, Cardiac & Pulmonary Rehabilitation, acquisition of the newest Mobile Mammography Unit, creation of the Ed & Gayle Goodman Sim Center, purchase of new ambulances and now the 5 South renovation. “I serve and support the Hospital Foundation because the money we raise improves and enhances the hospital, enabling it to provide the best medical care to our community,” said Dyess. “We can all be proud to support Baxter Regional, a locally owned, independent, state-of-the-art hospital.” “Our list of hospital giving opportunities includes items of a higher priority needed to keep the hospital operating at its full potential. There are other things the hospital needs which are often identified by a donor,” said Edwards. “An example is the bench outside the Medical Arts Building for visitors and patients. It is a gift that has been used every day since it was installed. “Gifts do not need to be funded all at once but can be pledged over time. For example, a donor can pledge a $100,000 gift over five years contributing $20,000 annually. “We are thankful for the generosity of our community, and no amount is too small. We are grateful for every dollar we receive, which is put to good use within our hospital.” n
BAXTER REGIONAL HOSPITAL FOUNDATION
M E N U O F G I V I N G O P P O RT U N I T I E S • 2 Ambulances, $300,000
• Surgical Table (Ortho use), $102,000
• 4 Ultrasound Machines (Radiology use), $545,000
• iNtuition Solution CT Cardiac Package (Cath Lab/TAVR), $100,000
• Nuclear Gamma Camera for Cardiovascular Imaging Clinic (for stress tests), $400,000
• Ultrasound Machine for Women’s Center (OB/Gyn), $82,500
• Endoscope Video System (Pulmonology use), $327,500
• 10 Outpatient Surgery Center Adult Stretchers, $39,700
• 2 Endoscopy Procedure Stretchers, $35,700
• Endoscope for Respiratory Therapy (ENT use), $7,893
• 5 Bariatric Recliners for 4 South Step Down Unit, $22,000
• Wheelchairs for PACU, $5,600
• 2 Bariatric Recliners for CVICU, $8,800
• Mobile Lift for 5 South Surgical Services Unit $5,400
Anyone interested in making a donation or seeking more information about giving opportunities may call Sarah Edwards at 870-508-1775 or Barney Larry at 870-508-1011. SPRING 2022 |
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Baxter Regional Clinics
DR. AUSTIN
BARBER
DR. DANIEL
DECKER
DR. DANIEL
ZAPATA
SPECIALISTS EXPAND REACH TO SERVE SURROUNDING COMMUNITIES BY DWAIN HEBDA
WHEN DR. DANIEL DECKER ARRIVED IN MOUNTAIN HOME 10 YEARS AGO, THE PRACTICE OF UROLOGY HERE WAS ON THE THRESHOLD OF A MAJOR TECHNOLOGICAL CHANGE. A decade later, Decker’s practice has exploded to the point Baxter Regional has brought in some reinforcements and with it, a future of unlimited possibilities within this underserved medical specialty. “When I first started here, one of the first initiatives for us was a robotic program,” Decker said. “That started in 2011 using the da Vinci (surgical robot), which was pretty novel in this area. Now, we’ve done hundreds of kidney and prostate surgeries robotically over the last decade. We’ve also done a really good job here adopting the latest laser treatments for enlarged BPH as well. “With my new medical partners, we’re moving on to hyper ablations, urolifts, the latest in lasers. It’s really been exciting as we
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go from me by myself to now six providers — three doctors and three nurse practitioners — in our practice.” Decker, who attended Wake Forest University Medical School in Winston-Salem, North Carolina, served his internship in general surgery and his residency in urology at the University of Texas Southwestern Medical Center in Dallas. “I met my wife (in Texas), and afterward I wanted to go to North Carolina, but she didn’t want to get too far from Texas,” he said. “I at least wanted to be somewhere that reminded me of North Carolina, and this did that. That’s sort of how we ended up here.” Decker has never regretted the decision, either personally or professionally. Urologists are some of the most in-demand medical specialists out there, and while he could live anywhere, he’s stayed put for the quality of life and the support of the health system. Now, he’s looking forward to expanding care even farther. PHOTOGRAPHY COURTESY BAXTER REGIONAL
“OUR FUTURE IS GETTING INTO THESE SECONDARY MARKETS WHERE WE KNOW THERE IS A LOT OF NEED IN THE SURROUNDING COMMUNITIES. ” - DR. DANIEL DECKER
“Our future is getting into these secondary markets where we know there is a lot of need in the surrounding communities,” he said. “The three of us are going in three different directions to set up ancillary clinics to provide a wider net of care locally. That’s where we have the ability to increase our brand and increase our worth by setting these secondary market clinics.” Joining Decker in this effort is Dr. Daniel Zapata, a native of Colombia, who’s been on board with Baxter Regional for 18 months. “What inspired me to go into medicine was the interactions with the patients and the ability to improve their quality of life,” Zapata said. “Also, urology is a very wide specialty in that we treat pretty much everything. It’s also surgical, which is something that I’ve always wanted to do. You can do minimal procedures in the office and do diagnostic procedures things. You don’t get all that in very many specialties.” Zapata, who comes from a long line of physicians, completed both his medical internship and residency in Memphis. He said the quality of urological care being provided in Mountain Home rivals that of much larger cities. SPRING 2022 |
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SPECIALIST SATELLITE CLINIC PHYSICIANS 5
DR. ALLAN
GOCIO
1
DR. ADAM
SMITHERMAN NEUROSURGERY Every other week at Hometown Clinic, Mountain View, AR
1
DR. LUCAS
BRADLEY
1 2
3
NEUROSURGERY Monthly at Burton Creek Rural Health Clinic, West Plains, MO
4 2
5
DR. DANIEL
ZAPATA
DECKER
UROLOGY Monthly at Crossroads Medical Clinic, Harrison, AR
1
DR. AUSTIN
BARBER
UROLOGY Monthly at Hometown Clinic, West Plains, MO
5
DR. JASON
MCCONNELL
ORTHOPAEDICS Every other week at Crossroads Medical Clinic, Harrison, AR 26
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DR. DON
FRANKLIN
ORTHOPAEDICS Twice a month at Burton Creek Rural Health Clinic, West Plains, MO Monthly at Access Medical Clinic, Ash Flat, AR
DR. WIN
MOORE
ORTHOPAEDICS Monthly at Hometown Clinic, Melbourne, AR
1
UROLOGY Monthly at Hometown Clinic, Mountain View, AR Monthly at Access Medical Clinic, Ash Flat, AR
DR. DANIEL
KNOX
ORTHOPAEDICS Twice a month at Burton Creek Rural Health Clinic, West Plains, MO
NEUROSURGERY Weekly at Crossroads Medical Clinic, Harrison, AR
4
DR. THOMAS
DR. RYAN
KRAFFT
PAIN MANAGEMENT Weekly at Hometown Clinic, West Plains, MO
5
DR. JOHN
NEIS
ENT Every other week at Women’s Health & Family Center, Harrison, AR
“We offer almost every procedure that is offered at the private practices in Memphis,” he said. “I think it’s a wonderful opportunity for all of us to continue to build on our practice, including expanding Baxter Regional Urology Clinic into satellite markets. That’s a very good way for us to reach a bigger population that is not currently getting up-to-date urological care, such as robotic surgeries and minimally invasive surgeries.” Zapata also praised the working relationship among his practice partners, saying they have found their stride quickly. “I do strongly believe that the three of us complement each other very well,” he said. “Not only our mindset and our partnership, but also as it translates into patient care. The way that we practice is very aligned. We tend to think the same way, and even when we
SPECIALIST SATELLITE CLINICS SERVICE AREAS 1
5
2
3
4
Primary Service Area
Secondary Service Area
SPECIALIST SATELLITE CLINICS 1
West Plains, MO
2
Ash Flat, AR
3
Melbourne, AR
4
Mountain View, AR
5
Harrison, AR
• Hometown Clinic at West Plains • Burton Creek Rural Health Clinic • Access Medical Clinic • Hometown Clinic at Melbourne • Hometown Clinic at Mountain View • Crossroads Medical Clinic • Women’s Health & Family Center
don’t, we’ve got a good rapport to talk through a particular case.” Rounding out the trio is Dr. Austin Barber, a native of Georgia, who has been part of the team for nine months. He echoed his colleagues, saying he came to Mountain Home thanks to the breadth of practice he could establish here. “Baxter Regional allows us to be able to do more comprehensive urology care for the community and to manage, from a urological standpoint, the majority of urologic issues here locally,” he
Tertiary Service Area
said. “We don’t have to transfer them to a larger facility or larger town. We practice at full capacity, and we can do everything we need to do because we have the latest technologies available.” Barber said expanding the Mountain Home practice into clinics in surrounding communities advances that mission even further. “Our main practice and clinics benefit the community because patients don’t have to travel to get standard urologic care,” he said. “That’s rare for a lot of rural communities to have an opportunity to have such quality specialists offering services that close to home.” After completing his undergraduate work at the University of Georgia, Barber was commissioned as an officer in the U.S. Air Force in 2008. He completed medical school in Georgia, then came to UAMS in Little Rock for his residency. Following that, he served four years in the U.S. Air Force, stationed at Keesler Air Force Base in Biloxi, Mississippi. He said he couldn’t imagine a better place to continue his medical career than Mountain Home. “I was practicing by myself in the Air Force for an extended period, and that was not a whole lot of fun,” he said. “I was looking for good partners, younger partners, who weren’t going to retire on me in two or three years. That was one criterion. “Also, I like small towns. The hospital had capabilities for everything I needed to do from a urology standpoint, and the community gave us what we were looking for to raise our family. We love the outdoors, everyone’s been super nice and we couldn’t be happier we’re here.” n SPRING 2022 |
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Baxter Regional Board Member
Upward ONWARD AND BY DWAIN HEBDA
MANY PEOPLE IN MOUNTAIN HOME AND THE VICINITY LOOK TO BAXTER REGIONAL WITH TREMENDOUS FEELINGS OF CIVIC PRIDE. Board Chairman Randy Hopper, who lives in nearby Flippin, is one of them. “Baxter Regional is impressive, to say the very least,” he said. “The senior leadership team is dedicated, they’re capable, they think strategically. I’m very impressed with them in every discipline. “But it’s much deeper than that. There’s a camaraderie or a spirit here that really is hard to put your finger on.” Hopper, who has been a member of the board for three years, said he agreed to serve in the hopes that he could contribute something of value to the organization. After seeing the level of excellence the hospital delivers every day, he was inspired all the more to be a part of the organization’s success. “When I was asked to join the board, I thought about it very carefully. I kept coming back to the fact that I wanted to make a contribution back to the community,” he said. “The fact is, I had no idea what that meant when I came onto the board. Every day I have just been so impressed.” One vivid example of the operational excellence at work here, Hopper said, is how the health system kept moving forward with goals and initiatives even as the hospital waged war on the coronavirus. Where some hospitals ground to a halt, Baxter Regional kept reaching onward and upward. “There have been lots of accomplishments,” he said. “We opened a new outpatient surgery center. There was the long drive to get to Magnet designation, and that happened last year. The thing I’ve been very impressed with is the new heart
“The senior leadership team is dedicated, they’re capable, they think strategically. ... There’s a camaraderie or a spirit here that really is hard to put your finger on.” 28
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procedure, the TAVR procedure. That went into place this past year. We’ve been named a best place to work, again, and we just broke ground on a new cancer center. “There were some things that probably had to be moved to the side laterally, but I don’t think anything ever got off the dashboard completely. As a board, we kept coming back and saying, ‘We really need to do these things because of our purpose. This is an obligation and responsibility we need to live up to.’” The laundry list of accomplishments wasn’t easy to achieve, of course, and neither are the challenges facing the organization going forward. Foremost among them, Hopper said, is the continuing labor shortage. “We’re all competing for the same population,” he said. “In private business, it’s a problem for all of us to attract the right talent. I think it really gets doubled down when you go into healthcare because there’s so much training and so many specialties. It’s really hard to stay in front of that. “Our hospital and our management group are working very hard to stay in front of not only wages, but benefits and atmosphere, developing a place to work that is a desirable place to work. That’s really what it’s about. There is serious burnout in healthcare nationally, and I know that our people have worked really, really hard. I really think we’ve weathered some things better than the national average because of how we treat our people in a very positive, compassionate manner.” Challenges and all, Hopper remains upbeat about the future of Baxter Regional, from the opening of the cancer center later this year to the ongoing challenge of providing world-class care with a small-town attitude. “I feel good about where we’re at,” he said. “I believe our commitment to remaining independent results in offering more comprehensive community-focused care than anyone else. In a word, it’s all about compassion, and I think we have that in abundance here. Yes, there’s a lot of things we’re going to have to overcome, but that’s just what our group does. When I look to the future, I’m optimistic.” n
PHOTOGRAPHY BY JASON MASTERS
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Board Chairman Randy Hopper at the
BAXTER REGIONAL Vexus Boats plantPULSE in Flippin,| Arkansas. 29
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BLESS the
CHILD
Pediatrician Shayna Wood, MD
BY DWAIN HEBDA
THERE WAS NEVER ANY DOUBT THAT SHAYNA WOOD’S CAREER WOULD BE, IN SOME FORM OR FASHION, HELPING OTHERS. The daughter of a pastor and the product of a small-town upbringing, she was raised in an environment where everyone looked out for everyone else — mind, body and spirit. “With my dad, we did the hospital visits. I always saw that side of things, of ministering to people and taking care of people from that perspective,” said Wood, now a pediatrician in Baxter Regional Med-Peds Clinic. “But I also loved the idea of taking care of them from the medicine side, too.
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PHOTOGRAPHY BY JASON MASTERS
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Dr. Shayna Wood at Baxter
| 33 BAXTER REGIONAL PULSE Regional Med-Peds Clinic.
“I think taking care of kids has to be a team approach between the parents and the physicians and nurses.”
I’ve always sort of felt like medicine is a ministry, and I think if you talk to a lot of physicians, they all feel like it’s a calling. That’s how I’ve always approached it as well.” Wood got a jump on her vocation by graduating from high school a year early and heading off to Arkansas State University in Jonesboro. From there, she received her medical training at UAMS in Little Rock where she first tasted the joys — and sorrows — of her chosen path. But even in the hard days, she saw her role clearly in helping families deal with illness and unthinkable loss. “I trained at Arkansas Children’s, and I actually did an extra three years of fellowship there in neonatology,” she said. “In the beginning, I was a neonatologist in Little Rock and worked in the NICU. I was there for a long time, and while I would like to say everybody makes it out fine and there’s never any death, that’s not true. “Death is a part of life, but that doesn’t mean that we walk it by ourselves. As physicians, if we can’t make it better, then at least we can be there for you.” Wood might still be in Little Rock had the time demands of being in the NICU not conflicted with her and her husband
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(Above) Dr. Shayna Wood was so impressed after a substitute stint at Baxter Regional in 2020 that it influenced her to move to Mountain Home permanently and join the Baxter Regional team.
Landon’s desire to have and raise a family of their own. “We started to have a bunch of kids,” she said. “We had a set of identical twin boys when our daughter was 22 months old. Being on call in the NICU, you’re actually in the hospital, and I was leaving my poor husband home with three kids under 2 for like, 48 hours at a time.” She chuckles at the memory. “We decided we may have to do something different, professionally speaking.” General pediatrics seemed like just the ticket, but the only question was where. Medical professionals of every specialty are in high demand these days, and Wood could have had her pick of assignments
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anywhere in Arkansas or out of state. But a substitute stint at Baxter Regional over Christmas of 2020 gave her a taste of the hospital and the community, planting a seed about where the next chapter of the family’s life might unfold. “I came up for about four or five days over that Christmas and after it was all done, I told my husband, ‘That hospital is so nice. Their labor and delivery department, those nurses are so good. They’re doing such good medicine up there,’” she said. “It was just a great week for me. It was so enjoyable, I told him, ‘I would totally go back there again and do that.’ “In March, I got a call from a recruiter who said they were looking for somebody
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permanent. We didn’t necessarily feel settled where we were at the time, and we knew we wanted to get somewhere to be settled before the kids got really into school. I said, ‘Let’s just look at it.’” Between the quality of the community, the excellence of the hospital and the unparalleled fishing in the area — a trait that won over Landon immediately — the family moved to Mountain Home last summer without a single look back. And, as Shayna soon found out, they weren’t alone on that path. “Several of us who graduated medical school together are actually here in Mountain Home now,” she said. “There are also people moving into this area from all over the country. They bring their kids in and I’m like, ‘What brought you to Mountain Home? How did you end up here?’ Everyone is drawn to the smalltown community. They love the lakes, they love the rivers, they feel like it’s a good place to raise their children.” Wood has also found it to be an enjoyable place to practice medicine, praising both hospital administration and employees for creating a one-of-a-kind environment. “They achieved Magnet status right as I was coming here,” she said. “While that’s impressive, I think the Magnet status is really just a reflection of the people who are here. The nurses take care of everyone just like they’re a family member through their commitment to excellence and doing what is above the standard of care. You can tell when you walk in, they’re here to take care of the patients because they love their patients. I appreciate that because that’s always been my take on it, too. “I think taking care of kids has to be a team approach between the parents and the physicians and nurses. I like that collaborative working relationship with parents because the parents are with the kids all the time. Are there challenges? Of course, there are challenges. There are going to be challenges wherever you are. But when you’re doing what you’re supposed to be doing in life, then you can get through everything else.” n
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FACTS ABOUT BECOMING AN RN
• You do NOT have to be an LPN first • High school graduates are eligible for the program • Must be 18 years old • Possible to become an RN two years after high school • Some employers only hire RNs who are graduates of accredited nursing programs
All undergraduate programs are fully accredited by the Accreditation Commission for Education in Nursing (ACEN) Benefits of ACEN Accreditation: • National mark of excellence • Some RN to BSN and graduate (MSN) programs only accept applicants from graduates of accredited registered nursing programs • Graduates of ACEN accredited programs are more likely to pass NCLEX (acenursing.org) Options in Mountain Home: • RN (traditional) Associate of Applied Science in Nursing (AASN) • LPN to AASN • LPN to AASN Online Option • RN to BSN* 100% of full-time faculty are MSN or doctorally prepared
Learn More: AState.edu/RN
Get started today in one of the top nursing programs in the state of Arkansas, located in the comfort of your own hometown. Some programs can be finished in as few as 12-24 months* Financial aid for those who qualify National Accreditation by the Accreditation Commission for Education in Nursing (ACEN) Ranked #9 on the list of Best Nursing Schools in the Eastern Region of the U.S. (NurseJournal.org)
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PHOTOGRAPHY BY JAMES MOORE
NEW BY DWAIN HEBDA
BAXTER REGIONAL RESIDENCY PROGRAMS GIVE NURSES A HEAD START
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BAXTER REGIONAL IS UNLIKE THE VAST MAJORITY OF HOSPITALS IN THE COUNTRY — AND ALMOST EVERY HOSPITAL OF ITS SIZE — FOR ITS MAGNET® STATUS, THE HIGHEST MARK OF EXCELLENCE IN NURSING ON EARTH. But the hospital is identical to every hospital in existence in the challenges it faces to attract and retain the nursing personnel necessary to serve its patients. Now, two new nurse residency programs are helping Baxter Regional address the latter problem, leveraging the kind of thinking and innovation that landed the small-town hospital its global recognition. The program, which targets newly
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hired licensed practical nurses (LPN) and nursing assistants, joins the hospital’s successful registered nurse (RN) residency program as a way to integrate personnel into hospital operations quickly. “This is boot camp for nurses and the nursing assistants. That’s exactly the way we explain it,” said Sarah Brozynski, Baxter Regional’s director of education, who heads up the three programs. “The purpose of the residency program is to develop technical skills and get them used to working in an acute care setting. “We also teach them how to process situations through critical thinking, especially the LPNs, because
(Previous Spread and Above) The newly hired LPNs work with Kelsey Gregory, BSN, RN, Clinical Educator, and other preceptors in the residency program to develop technical skills and get them used to working in an acute care setting.
SARAH BROZYNSKI, Baxter Regional’s Director of Education
their formal training is only three semesters long in the academic world. They come to us, and although they have basic nursing skills, we have to brace them up a little bit, get them to think and to anticipate and to learn how to work with their RN counterparts.” The idea to launch a residency program for LPNs and nursing assistants was born out of Baxter Regional’s RN residency that has been in existence here since 2013. “If you look at our RN residency, we’ve put over 100 nurses through that program. One of the reasons they tell us they chose Baxter Regional is because of the residency,” Brozynski said. “Now, one of the reasons the LPNs are coming to us is because we have
a residency. For the next incoming class, we already have people asking if we’re going to do it again, and we’ve let them know these programs are here to stay.” Two elements make Baxter Regional’s residency training as effective as it is. The first is the Ed & Gayle Goodman Sim Center that the hospital opened about a year ago, providing medical manikins for nursing residents to practice on. “The lab mimics a real hospital unit,” Brozynski said. “The clinical educators set up the patient rooms with manikins who respond to algorithms. We can make the blood pressures rise, we can make them dip, we can make them cry, we can make them moan. We’ll have several things going on in the SPRING 2022 |
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KELSEY GREGORY, BSN, RN, Clinical Educator AMY MYERS, MSN, RN, NPD-BC, RN Residency Coordinator
rooms at the same time. Then we’ll throw a code in there, and we look to see how the nurse responds, what the response time is for taking vitals, how do they react when a patient goes unresponsive, how long it takes them to call a Code Blue. “We tie all those skills together by simulating a situation. We’re also videotaping everything, so we’re able to time everything, then we roll the tape back to coach the student and give them a chance to self-audit their performance.” The second, equally critical element of the program is the role of preceptors, experienced nurses who serve as real-world, real-time mentors to the newcomer. Preceptors have long been used in
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HANNAH BLASDEL, BSN, RN, Clinical Educator
nursing circles, and Baxter Regional has taken this time-honored tactic and enhanced it to provide more informed, consistent training. “We really focus on the preceptors heavily,” Brozynski said. “The preceptors have professional development. They understand adult learning principles. Their job is to work on competence and confidence. They’re teaching the preceptees how to recognize when a patient or a patient family member is in need, how to respond to circumstances where the family is very happy and also how to respond when they have some concerns. “One thing that sets us apart in particular is we do what’s called a married preceptor state. What
CHRIS AUSTIN, MSN, RN, PCCN, Clinical Educator
(This Spread) The preceptors, who are experienced nurses, serve as mentors to the preceptees in the new residency program for LPNs and nursing assistants. These new programs are born out of Baxter Regional's RN residency that has been in existence here since 2013.
SARAH BROZYNSKI, Director of Education
that means is, not only is it one-on-one training, but you’re married together. You can’t go take care of a patient without your preceptee right with you, and the preceptee is never left alone.” Brozynski said the three programs not only result in better, more informed care for patients while helping to maintain staffing levels, but they also build camaraderie and live up to the highest expectations of Baxter Regional’s Magnet® status. That is, to advance and improve the practice of nursing using the latest in technology combined with the best in individualized, one-on-one training. “We’re using artificial intelligence technology, IBM Watson, to evaluate nurses’ critical-thinking
skills and their knowledge of nursing,” she said. “They sit down for about three hours, and they take this initial assessment. Watson is smart enough to analyze what’s being typed and gives us a report that maps out learning opportunities for our people. And then, we combine that with the preceptors. “I also think what’s important to know is the clinical educators are coming off the bedside. They’re not retired from the bedside and gone full time into education. They are so fresh that they know exactly what is going on in those units, and they’re passing on that knowledge. It makes the training very relevant and plays a tremendous role in the future success of our nurses.” n SPRING 2022 |
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The
FUTURE is NOW BY DWAIN HEBDA
WHEN DR. ALLAN GOCIO GRADUATED MEDICAL SCHOOL IN 1978, ABOUT THE ONLY LASERS THAT WERE IN THE PUBLIC CONSCIOUSNESS WERE THOSE APPEARING IN THE PREVIOUS SUMMER’S BLOCKBUSTER MOVIE “STAR WARS.” Times have certainly changed from those days, as Gocio is quick to admit. “We got our first CT scanner when I was a junior medical student. We didn’t get an MRI scanner until I’d been in practice about four years,” he said. “The medical technology has really progressed since then.”
(Right) Dr. Adam Smitherman with the Mazor Robot in the recently renovated OR 5. This room was expanded to house the equipment space needed for the new technology in the Medtronic Robot as well the O - Arm and da Vinci.
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PHOTOGRAPHY BY JASON MASTERS
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“THE ROBOT TAKES THE NEXT STEP FORWARD WITH THIS TECHNOLOGY BY USING A ROBOTIC ARM AS AN AIMING DEVICE AND A TOOL HOLDER TO POSITION YOU FOR YOUR SURGERY. IT GIVES YOU A MUCH MORE ACCURATE PLACEMENT OF SPINAL HARDWARE, WHICH IS WHAT WE’RE USING IT FOR.” - DR. ALLAN GOCIO
Staying in the medical field for four decades as he has, Gocio has had the opportunity to put his hands on many of those advancements, the most recent being the Mazor Robot surgical laser, which came into service at Baxter Regional Health System last summer. “The Mazor Robot actually builds on a concept that already existed called navigational surgery,” he said. “This is where you take imaging of the patient you’re working on, whether it’s the brain or the spine, and you use virtual images to guide you. “The robot takes the next step forward with this technology by using a robotic arm as an aiming device and a tool holder to position you for your surgery, regardless of what area of the body you’re working on. It gives you a much more accurate placement of spinal hardware, which is what we’re using it for.” If the Mazor Robot sounds like something unexpected in a hospital the size of Baxter Regional, it’s because you generally don’t find it outside of much larger health care facilities. “This technology is very rare for a hospital our size, but then, it’s very rare for a hospital our size to have three neurosurgeons,
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(Above) The Mazor Robot guides the surgeon on the placement of screws for spinal surgery. Photo courtesy of Medtronic. (Right) from left: Dr. Adam Smitherman, Dr. Lucas Bradley and Dr. Allan Gocio with Baxter Regional's Mazor Robot surgical laser.
too,” said Dr. Lucas Bradley. “I’d say there are several other hospitals in the state that are utilizing a robot of some sort, but they’re much larger than we are. “It’s a big advantage for us to be able to offer the Mazor Robot. Every medical branch, surgical or nonsurgical, is becoming more and more complex with more and more devices and technology. You have to be able to provide the most up-to-date care using this kind of equipment; there’s just no way around it. Baxter Regional’s willingness to invest in that technology and training is huge.” Bradley said the Mazor replaces technology that, while highly assistive in navigating the patient, still relies on the surgeon’s hand-eye placement of both hardware and the screws to hold it
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“BEING ABLE TO USE THIS FOR MINIMALLY INVASIVE CORRECTION OF SCOLIOSIS BROADENS OUR WINDOW FOR PATIENTS WHO NEED CORRECTION.” - DR. ADAM SMITHERMAN
in place. With the new machine, the robot guides the placement of screws with far more accuracy than any human being can. Dr. Adam Smitherman said the big advantage to using the robot comes down to developing a more detailed working plan for the operating room. “Preplanning is a big part of that,” he said. “Everybody always thinks about spine surgery and having problems with that, especially taking into effect the global spine itself. This lets us think about ways we can help correct things as a whole while focusing on smaller segments. We can actually take a look at everything and see how we may affect that overall alignment better by preplanning these screws. “Being able to line up incisions or prebend rods also helps, making surgery even more minimally invasive. It just makes it a much smoother process for us and the patient, all-around.” Smitherman also said the robot laser allows for less invasive surgery across a wider patient population base. “I think the part that’s going to be really exciting with it is where we can use it for scoliosis,” he said. “Being able to use this for minimally invasive correction of scoliosis broadens our window for patients who need correction. We may be able to offer surgery to patients who wouldn’t be candidates today, people who are older and wouldn’t be able to tolerate a big, open surgery.
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(Above) The Mazor Robot combines pre-operative planning tools with intraoperative guidance. Photo courtesy of Medtronic.
“This device helps decrease blood loss, it helps decrease infection rate and it helps decrease OR time. That is where it shines, on the differences between doing the open procedures and the minimally invasive procedures.” The full application of the technology is yet to be realized. Gocio noted in some areas, the Mazor Robot is being used to remove brain tumors and other delicate procedures. He said while there’s currently no plan to apply Baxter Regional’s device in this manner, the future is ripe with possibilities. “Robots will become more sophisticated. Right now, the robot is mainly a tool holder and a positioner or a guide,” he said. “There will be multiple arms, ultimately, with multiple devices that connect, and there will be more robotic overlay on the surgeries. “On the horizon, we’ll move into the cervical spine region, the neck area, which is much more complex and a much more dangerous place to operate. Removing bones, decompression of the spine or manipulation of the bones safely is the future. Not just guiding hand tools to the proper alignment and proper trajectory, but also manipulating the tools to do more of the work.” n
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ROCK STEADY BOXERS
FIGHT PARKINSON’S DISEASE WITH EXERCISE AND DETERMINATION BY DEBORAH STANUCH
THEY MAY NOT LOOK LIKE MOST FIGHTERS IN A BOXING RING, BUT DEBBIE HAGEE AND MARGO MAGLIONE, TWO PARTICIPANTS AND COACHES OF ROCK STEADY BOXING MOUNTAIN HOME, A PROGRAM OF THE MRUK FAMILY EDUCATION CENTER ON AGING, FIGHT THEIR OWN PERSONAL BATTLES WITH PARKINSON’S DISEASE EVERY DAY. Hagee clearly remembers the day nearly six years ago when she was told she had Parkinson’s.
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She admits going into denial for a few months until she learned about Rock Steady Boxing and decided, “What did I have to lose?” Rock Steady Boxing is a non-contact boxing and fitness program dedicated to helping people who are diagnosed with all levels of Parkinson’s disease. The innovative classes, divided into four levels based upon each person’s unique Parkinson’s symptoms and overall level of fitness, get results and even slow down the disease’s progression. Level 1 provides a high-intensity workout; Level 2, for those with
(Above) Debbie Hagee was diagnosed with Parkinson's nearly six years ago and is now a Rock Steady Boxing participant and coach. (Right) Lisa Gilcrease became a volunteer and certified coach at Rock Steady Boxing after attending a class with her friend, Margo Maglione.
PHOTOGRAPHY BY JAMES MOORE
THE INNOVATIVE CLASSES, DIVIDED INTO FOUR LEVELS BASED UPON EACH PERSON’S UNIQUE PARKINSON’S SYMPTOMS AND OVERALL LEVEL OF FITNESS, GET RESULTS AND EVEN SLOW DOWN THE DISEASE’S PROGRESSION. SPRING 2022 |
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“... THESE WOMEN WHO HAVE PARKINSON’S, ARE AMAZING AND INSPIRING. NOT ONLY DO THEY IDENTIFY WITH THE STUDENTS THEY COACH, BUT THEY ARE ABLE TO EMPATHIZE WITH THEM IN A VERY SPECIAL WAY.” - DIAHANNE VANGULICK
COORDINATOR AT THE MRUK CENTER FAMILY EDUCATION CENTER
more visible symptoms, is modified as needed; Level 3 involves much slower movements and Level 4, for those in the later stage of the disease, has one-on-one assistance to reduce the risk of falls. “We currently have 26 active participants. Our classes meet the needs of all levels of Parkinson’s disease,” said Diahanne VanGulick, coordinator at the Mruk Family Education Center on Aging who oversees the Rock Steady Boxing Program. “No one is exempt!” “They (the Rock Steady Boxing group) became my second family,” said Hagee. “Everyone was friendly, concerned, supportive and understanding. It was a place I could let my hair down.” In addition to being a participant, she volunteered and became a certified coach. “My goal is to help my fighters realize they can slow the progression of the disease. When they look at me, they see someone who is going through it, too. What’s the saying? ‘Been there, done that, got the T-shirt.’” Maglione says she had always been physically active. When she was diagnosed with Parkinson’s 11 years ago, she was living in the St. Louis area where she became involved with research studies on the impact of exercise slowing the disease’s progression being conducted at Washington University. After moving to the Twin Lakes Area, she saw a flyer on Rock Steady Boxing at her doctor’s office
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and became a participant and then a certified coach. “I was so grateful to the other Rock Steady coaches for all the help and hope they gave me. They inspired me to give back to others with Parkinson’s.” The disease did not slow Maglione down. She continued water skiing, rock climbing and playing tennis. While playing tennis with her friend Lisa Gilcrease, who does not have Parkinson’s, she talked frequently and enthusiastically about the boxing program. “To satisfy my curiosity, I accepted her invitation to attend a class,” said Gilcrease who was so impressed by the program and participants, she became a volunteer, a certified coach and is now the Rock Steady assistant. “I’ve learned combating the symptoms of Parkinson’s isn’t easy, but working with this group of fighters, I see such determination, strength and dedication. It makes me want to fight beside them.” “Lisa is one of the most creative people I have met,” said VanGulick. “She brings so many talents and skills to our program. Her love and compassion for each of our fighters is always evident in the way she listens and guides. We are so blessed to have her! “Debbie and Margo, these women who have Parkinson’s, are amazing and inspiring. Not only do they identify with the students they coach, but they are able to empathize with them in a very special way. The challenges they face because of this
(Above) Margo Maglione was inspired to give back to her fellow Parkinson's patients at Rock Steady Boxing and became a certified coach.
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disease are usually not something most people see or understand. But I know they face those challenges every day and yet they are two of the most determined women I have ever met. “We send a message of hope and motivation to our boxers,” said VanGulick. “They may not win titles or trophies, but they are all champions in the Rock Steady Boxing Ring.”
The Rock Steady Boxing program was introduced to Baxter Regional and the Mruk Center in 2016 by attorney Randall Drake, who serves on the Hospital Foundation Board of Directors as the deferred gifts chairman. Baxter Regional was the first hospital in Arkansas to offer the program which today is offered at over 800 locations in the United States.
(Above) from left: Margo Maglione, Lisa Gilcrease and Debbie Hagee are helping fight Parkinson's disease at Rock Steady Boxing Mountain Home.
FOR INFORMATION ON THE ROCK STEADY BOXING MOUNTAIN HOME PROGRAM, CALL VANGULICK AT 870-508-3880.
Participants will need a primary care physician’s authorization and a referral to the Baxter Regional Physical Therapy Department. All classes are held at the Baxter Regional Wellness Education Center located at 2545 Highway 5 North in Mountain Home. n
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Baxter Regional Wellness
A SUCCESSFUL FITNESS PROGRAM DEPENDS ON MOTIVATION BY DEBORAH STANUCH
Tony Williams, a certified pharmacy technician at Baxter Regional, | over | SPRING BAXTER REGIONAL has lost 30 pounds by beingPULSE consistent with his 2022 routine. 56
PHOTOGRAPHY BY JAMES MOORE
MOTIVATION IS KEY TO A SUCCESSFUL FITNESS PROGRAM ACCORDING TO JONNY HARVEY, OCCUPATIONAL HEALTH COORDINATOR AT BAXTER REGIONAL. “You have to be motivated. You have to find your own motivation.” Tony Williams, a certified pharmacy technician at Baxter Regional, agrees with Harvey as he continues his year journey to fitness and a healthy lifestyle. “You have to want it, have the drive and hold yourself accountable.” Tony, who is in his early 30s, found his motivation over a year ago when he stepped on a scale and said, “This is too much.” He began with his diet and began exercising, something he admits he hadn’t done in a long time. He turned to a friend at work, Tanner Hammond, a pharmacist at Baxter Regional, who helped him develop a program that included diet, nutrition and an exercise routine involving weight lifting. Tony and Tanner headed to the Knox Wellness Center beginning with body weight movements to learn correct form and reduce the risk of injury. They then added weights to the routine using dumbbells and barbells. Tony became progressively stronger and can now work out alone. “He took on this journey for himself,” said Hammond. “I helped him do this safely. Although we still work out together,
Located on the third floor of the Medical Arts Building, the Knox Wellness Center has a wide range of equipment including a cardio area with treadmills, bikes and elliptical machines; weight machines and free weights; boxing equipment; and an area for stretching and calisthenics as well as a television for the exercise equipment. A secure facility, it is open 24 hours a day, 7 days a week, 365 days a year.
The Knox Fitness Center is free to all hospital physicians, employees, volunteers and their families. SPRING 2022 |
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“HE’S BEEN VERY CONSISTENT WORKING OUT THREE DAYS A WEEK AND HAS SEEN GREAT RESULTS IN THE PAST YEAR. WORKING THE LARGER MUSCLE GROUPS IS THE BEST APPROACH TO INCREASE STRENGTH AND METABOLISM.” he has progressed enough to lift without someone present.” “Tony came in with no knowledge of weight lifting but he learned pretty quickly,” said Harvey. “He’s been very consistent working out three days a week and has seen great results in the past year. Working the larger muscle groups is the best approach to increase strength and metabolism. “Other gym members comment on his results, and that helps keep him motivated. Positive feedback keeps everyone going,” according to Harvey. Hammond said his friend is more active now, and the confidence boost from his physical progress extends outside the weight room. Tony says his wife is supportive and he gets support from co-workers, but you have to do it yourself. “You have to want it, have the drive and hold yourself accountable. You come to this point yourself.” “It doesn’t take a lot to get started,” said Hammond. “Just make the decision to start. Once you start it gets easier, you’ll have small victories along the way, and it becomes part of your routine.” “Tony has been very consistent, working out three days a week. In the past year he has decreased his weight by over 30 pounds, built his strength and become very functionally strong,” said Harvey. “He’s an inspiration and proves it’s never too late to start,” said Harvey. Tony plans to continue lifting weights the rest of his life and is planning to build a gym in his home. n
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Comprehensive care. Experts you trust. CALL (870) 508-6020 FOR MORE INFORMATION OR AN APPOINTMENT. MOUNTAIN HOME | HARRISON | MOUNTAIN VIEW | ASH FLAT | WEST PLAINS
www.baxterregional.org
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Baxter Regional Nutrition
Seasonal
Dishes
SPRING IS THE ULTIMATE SEASON FOR FRESH PRODUCE
Enjoy the fresh flavors of the season with dishes that incorporate the jewels of spring. Bright and refreshing, our veggie-forward dishes will awaken your taste buds.
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BY JAMES STEFIUK | BAXTER REGIONAL PULSE | SPRING 2022
Pasta Primavera INGREDIENTS:
16 ounces rotini pasta 1 tablespoon olive oil 1/2 pound asparagus, cut into 1½ inch pieces 1 yellow or red bell pepper, cut into 1½ inch pieces 2 cups small broccoli florets 1 zucchini, chopped Salt and black pepper to taste 3 tablespoons unsalted butter 1 small onion, minced 5 garlic cloves, minced Zest of 1 lemon Dash crushed red pepper flakes 1 cup vegetable broth 1/2 cup heavy cream 3 tablespoons lemon juice, divided 1 cup frozen peas 1 cup shredded Parmesan cheese 1 pint halved cherry or grape tomatoes 1/2 cup chopped basil Crushed red pepper flakes, for garnish
INSTRUCTIONS:
Bring a large pot of water to a boil. Add salt and pasta to boiling water. Cook to desired doneness. Drain and pour pasta back into the pot. Meanwhile, in a large skillet, heat the olive oil over medium high heat. Add the asparagus, peppers and broccoli. Sauté for 2 to 3 minutes, stirring occasionally. Add in the zucchini and cook for 1 to 2 more minutes, or until vegetables are crisp tender. Season vegetables with salt and pepper, to taste. Transfer the vegetables to a large plate or bowl. Place the skillet back on the stove. Melt the butter over medium heat. Add the onion and garlic and cook for 2 minutes. Stir in the lemon zest and vegetable broth. Simmer until the broth reduces by half, about 4 to 5 minutes. Stir in the heavy cream and 2 tablespoons of lemon juice. Stir the peas into the pot with the pasta. Stir in the cooked vegetables. Pour the lemon cream sauce over the pasta and vegetables and stir until well combined. Stir in the Parmesan cheese and remaining tablespoon of fresh lemon juice. Gently stir in the tomatoes and basil. Season with salt and black pepper to taste. Pour the pasta primavera into a large serving bowl or dish. Garnish with parsley, extra Parmesan cheese and crushed red pepper flakes. Serve warm. (adapted from Two Peas & Their Pod)
HEALTHCARE FOR A LIFETIME Since 1991
Edward L. White, M.D. | Michael E. Hodges, M.D. | Cathy J. Clary, M.D. Timothy McNamara, M.D. | Deborah Leach, APRN | Debra Schulte, APRN Tanner Brannon, APRN | Amanda Carson, APRN 614 NORTH TOWN, MTN. HOME, AR 72653-3105 | (870) 425-3131 | NCAMEDICAL.COM SPRING 2022 |
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Old Fashioned Strawberry Rhubarb Crisp INGREDIENTS: FOR THE STRAWBERRY RHUBARB FILLING:
2 pounds rhubarb stalks, sliced 1/2" thick (about 8 cups) 1¼ cups sugar, divided 1 pound fresh strawberries, hulled and quartered 3 tablespoons cornstarch 1 tablespoon fresh lemon juice 1 teaspoon pure vanilla extract
FOR THE TOPPING:
1/2 cup unsalted butter, softened 1½ cups packed brown sugar 1½ cups all-purpose flour 1¼ cups quick-cooking rolled oats ¼ cup canola oil 2 teaspoons cinnamon 1 teaspoon kosher salt
INSTRUCTIONS: Preheat oven to 375° F.
For the strawberry rhubarb filling: In a medium bowl, toss the rhubarb with 3/4 cup of the sugar and let stand for 15 minutes, stirring occasionally. In another medium bowl, toss the strawberries with the remaining 1/2 cup sugar and let stand for 10 minutes, stirring occasionally. Using a large, slotted spoon, transfer the rhubarb to the strawberries and discard any rhubarb juice. Add the cornstarch, lemon juice and vanilla to the fruit and stir well. Transfer the mixture to a 9-by-13 inch baking dish. For the topping: Combine all the topping ingredients in a medium bowl. Using a food processor, mix ingredients together until large crumbs form. Break up some of the large chunks with your hands. Sprinkle topping evenly over the filling. I like to leave a small bare edge around the perimeter, to see the pretty strawberry rhubarb mixture. Bake for 25 minutes. Reduce oven temperature to 325° F. If the topping is browning quickly, tent a piece of foil very loosely over the pan, so the foil is not touching the crisp. Continue baking for another 30 to 35 minutes, or until the fruit filling is thickened and bubbling quite a bit and the topping is nicely browned. Let the crisp rest for about 20 minutes before serving. (adapted from A Farmgirl’s Dabbles)
Nicoise Salad INGREDIENTS
1/2 cup plus 2 tablespoons extra-virgin olive oil 1/4 cup balsamic vinegar Kosher salt and pepper 4 large hard-boiled eggs 8 ounces French-style green beans, trimmed 1/2 lemon 4 jarred artichoke hearts, quartered 4 ounces mixed baby greens 1 pint cherry tomatoes, halved 3 bell peppers, preferably a mix of colors, thinly sliced Two 5-ounce pouches good-quality tuna, drained and flaked 1 cup Kalamata olives, halved Chopped basil, for garnish
INSTRUCTIONS
In a small bowl, gradually whisk the olive oil into the vinegar until incorporated. Season with salt and pepper. Set aside. In a medium saucepan, cover the eggs with 2 inches of water and bring to a boil. Cover the pan, remove from the heat and let stand for 10 minutes. Transfer the eggs to a bowl of ice water and let cool completely. Peel and halve them (feel free to use your own hard-boiled egg prep for this part). Meanwhile, in a medium saucepan of salted boiling water, blanch the beans until crisp-tender, about 3 minutes. Drain and transfer to another ice bath to cool. Arrange the baby greens on a platter. Arrange the artichokes, tomatoes, bell peppers, tuna, anchovies, olives, eggs and green beans on the greens in rows. Drizzle half of the dressing over the salad and garnish with basil. Serve the remaining dressing on the side. (adapted from Food & Wine) n
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Chaplain’s Corner
COPING WITH STRESS FROM A
SPIRITUAL PERSPECTIVE BY REV. RANDALL D. LUDWIG, DMIN, BCC
ONE OF THE MOST COMMON TOPICS OF CONVERSATION I HAVE WITH PATIENTS IS THE AMOUNT OF STRESS IN THEIR LIVES. Whether it be the complexity of family dynamics, financial insecurity or even the worry brought on by their illness, stress plays a big part in our lives. Certain levels of stress and anxiety are normal and can usually be dealt with in a healthy fashion; however, there are times when stress overwhelms us and becomes detrimental to our health. One of the first things I talk about with someone who appears to be having a difficult time managing their stress is, “Tell me about your spiritual life.” Inevitably, they will respond by telling me about the denomination they are affiliated with, or the church they attend or even that they are not a religious person at all. My reply is, “Don’t tell me about your religion, tell me about your spirituality. Tell me what makes you, you. Tell me what you believe in. Share with me what makes you happy, what brings you peace, what gives your life purpose?” It is important for us to realize that our spirituality enables us to walk through this life believing that there is a God or a higher power greater than ourselves — that there is someone or something that is in ultimate control and allows us to surrender our worries and troubles to. The greatest sense of peace we can have is knowing that we are never alone. To have an understanding that the sum total of our existence is greater than the individual aspects of our day-to-day lives, and that we are loved unconditionally, enables us to live worry-free.
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Practicing spiritual principles can be an effective way to manage stress. Here are a few ways to incorporate spiritual stress management into your life: Prayer. Being in communion with our higher power is the most effective way to alleviate stress. So often our prayers are centered on asking for something; asking to be delivered from a certain circumstance. In reality, our prayer time should be spent giving thanks for the many blessings in our lives. When we focus on the positive things, we sustain a more joyful attitude. Meditation. Designating a comfortable and relaxing place as your “Holy Space” and going there for a few minutes every day can help you unwind and re-energize. Sitting in silence, listening for the still, small voice that has no sound can be one of the most spiritual things we can do. Try to imagine yourself hovering high above the earth. Looking down upon your problems can help put them into perspective. Yoga. Yoga and exercise help to calm the mind and strengthen the body. There are many different styles and intensity levels of yoga — one to fit every person’s ability. Another healthy exercise is simply walking. When walking, we should freely swing our arms. So much of our stress is physically stored in our neck and shoulders. This movement allows the muscles to relax and expand. Regardless of what stress-relieving practices you choose, the main thing is to just start. Connecting with your spiritual inner self will deepen your relationship with God and provide a more peaceful existence — and that gives us hope! n
To give real service you must add something which cannot be bought or measured with money, and that is
SINCERITY AND
INTEGRITY.
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