DECATUR – It's hard to tell that Maya has trouble gaining weight by the way she giggles after putting crayons in her mouth. But for her parents, Kristine Chenoweth and Morton Tipkey, every extra ounce on the scale is a small victory.
“It's the worst challenge of my whole life,” Chenoweth said.
Maya was born blue, an effect of her congenital heart condition that also required three surgeries to repair the hole in her heart. Now, at almost 2 years old, she gets a visit from Millikin University nursing students as part of her care through the Community Health Improvement Center.
On the way to Maya's house, senior nursing student Keely Doolan made sure to pick up a Dora the Explorer coloring book. By now Doolan is familiar with the toddler's tendency to draw on whatever is available, including medical notes, but when she first started meeting patients in their home it was a little intimidating.
“You don't know what to expect,” Doolan said.
Since 1985, the School of Nursing and CHIC have teamed up to give student nurses hands-on experience through a capstone course. The Community Health Nursing class gives students the chance to apply what they've learned in a hospital setting and outside as well with school nurses or case managing.
“When we visit families in their home they could almost have any kind of issue,” said Jo Carter, the course instructor.
Each student is assigned 30 minute appointments for up to five weekly or biweekly household visits, which can range from a premature baby, chronic disease management or an older individual with Alzheimer's disease. That half hour meeting may generate five issues the nurses need to solve, such as making sure a needed prescription gets to their home.
The students will help manage the many medications prescribed by various specialists for some patients. They monitor blood pressure and blood sugar levels and take the extra step of explaining what they mean. For patients looking to get more active, they'll set up a gradual walking schedule.
It's these senior nursing student's last class before they graduate in 66 days, not that any of them are counting. For about half of them, graduation means finding work in pediatrics the others may return to school down the line to become nurse practitioners.
But for now this class is their first experience going out into the community and providing health advice in a patient's home. Moving health care into a patient's home requires using different strategies.
“The patients rule, they're the dominant force in their home,” Carter said. “It's that challenge that makes it fun.”
Student nurses have been visiting Margaret Williams in her home for nearly three years. At 64, she is bedridden after a stroke put her in rehab where she then had a heart attack.
When Williams recently found out she was on the verge of being diabetic, she changed her diet and stopped drinking soda, but the hardest thing to give up was her black-eyed peas.
So when student nurse Katie Looby brought her healthy snacks and a list of foods that were off limits and the peas weren't on it, she was ecstatic.
“This is a wonderful thing,” Williams said. “They get things done.”
As Looby talked about food portions, Carter encouraged Williams to keep up the good work.
“What you're doing is working,” Carter said.
The nurses start their mornings early twice a week in a room at the back of CHIC before being sent out to their assigned homes of CHIC patients. Last Thursday, a group of six practiced taking blood samples on one another to test their lipid levels.
Things such as taking blood, or “sticking” as they call it, or eating the diet of a diabetic for three days are ways Carter helps her students build empathy for their patients. From Carter's perspective, this class is an eye opener for them.
“They learn that people with few resources live with dignity,” Carter said.
Much of what they do is relatively new to the nursing field, with students serving an educational and coaching role. Technology is driving a lot of procedures that could only be found in hospitals into people's homes, so they can manage their own care. Carter said it forces the students to get creative when it comes to researching medical topics for patients.
“Sometimes it's not in their textbooks,” Carter said.
The class is mutually beneficial, with students getting practical experience and CHIC getting more healthcare professionals into the community. Several students have gone on to work at CHIC, including its executive director Tanya Andricks.
“When you work with people and treat them with respect, it's amazing what kind of results you get,” Carter said.