We all know how much I love alternate experience days were we get to break away from the somewhat monotonous clinical experience and go somewhere new and exciting!
One day during the semester, I shadowed two nurses at the hospital's Women’s Health Clinic. Thursday is the Clinic's High-Risk day where they see patients who are labeled high risk for varying reasons such as seizure disorders, diabetes, thyroid disorders, chronic high blood pressure, previous preterm deliveries, multiples, or even drug use. The patients usually come in every week for the duration of their pregnancies just to ensure things are going smoothly.
The clinic runs with the help of two nurse practitioners, one attending physician, several residents, many medical assistants, and a handful of registered nurses. The NPs see patients for annual exams, contraceptives, and sexually transmitted diseases while the residents primarily see the pregnant moms who come in. The medical assistants accompany the residents for exams, help patients, and assist with tests.
I spent my day observing the roles of two of the RNs, K and C. While I would have thought K would do more of what the medical assistants did, she helped check in patients, obtain vitals, administer vaccines, and perform blood draws. C was a case manager, and her job was making sure all of her patients were progressing well with their plans of care throughout their pregnancies.
Regarding the population, I learned from K that 90% of all of the patients the clinic sees receives healthcare insurance from Medicaid. Additionally, some of the patients who aren’t on Medicaid may have seen the office on a list of insurance-approved clinics and come in “by accident,” and other non-Medicaid patients are often previous patients who are more financially stable now but still want to continue being seen by the same healthcare providers.
Many of the patients were in their teens and early 20s. Many Americans on Medicaid are at a low economic status, and I observed the majority of the patients seemed less educated and even sometimes ill-mannered in comparison to other patients I've observed. Some patients responded to our care with short, one-word answers given with attitudes, while a few were friendly and kind. A few people on the day's list neglected to arrive to their appointments without even the courtesy of a phone call. But like anywhere else, the Clinic sees many different people, and financial status is not always indicative to patients' demeanors or health-seeking behaviors and choices.
A few scenarios of high-risk mothers we saw in the clinic are as follows: a woman in her mid-30s at 12 weeks gestation with a complication of a right ovarian cyst, a 16 year old at 8.5 months gestation with complications from a previous brain aneurism and recurring headaches. Then we had a more typical case of a woman with Type 1 diabetes carrying her second baby. Her first baby was preterm, so she is hoping to have a healthy, term infant. We also saw a 19 year old woman pregnant with her second child, and she produces an antibody causing hydrops fetalis, a serious condition where a fetus becomes edematous in various areas. Overall, it seemed that we saw more diabetic patients than anything else.
After calling a patient in from the waiting room, K would obtain her weight. We'd then go into a room where we'd chat for a few minutes with the patient and - if she came with someone - her partner, children, or mother. We also tested each patient's urine for sugar and protein, and if the patient was diabetic, ketones. Other than the occasional vaccine or blood draw, that's what K's job entailed. It may not seem like much, but since most of the patients come in on a weekly basis, K has the opportunity to form trusting relationships with each of them, and I found it refreshing to observe.
There are two RNs who are case managers at the Clinic, and I spent time with one of them, C. Each patient at the clinic is assigned a case manager who follows her throughout her pregnancy to ensure she's adhering to her plan of care and is taking optimal care of herself and her fetus. C has three formal discussions spread out over each woman's pregnancy where she goes down thorough checklists encouraging the mothers to attend a prenatal or parenting class, maintain an optimal diet, adhere to any prenatal medications, and even obtain a safe car seat and crib. She arms them with support and provides additional resources such as WIC. C also comes in to check on her patients at every visit, and although less formally, she still assesses each patient's progress in preparing for the remainder of her pregnancy, labor and delivery, and living at home with a new baby. She has a great responsibility to teach her patients especially since many of the Clinic's pregnancies are not planned, and many of the mothers are unmarried, unemployed or of a low income. In some cases, the patients may not have any support available to them at home.
Overall, I was surprised at the RN roles in the Clinic. I had been expecting neither, but after spending the day with both K and C, I realized that both of them play vital roles in the lives of their patients. I think seeing the same RNs at each office visit is critical to every patient in all clinical fields as it encourages patient trust and increases the positive image of the professional RN. The more patients trust nurses, the more they will feel comfortable confiding in them and asking them health-seeking questions. I believe nurses can increase patients' image of the healthcare system overall, even in an age where people don't seek care because the system is so complicated, expensive, and downright frightening. Patients often leave a physician's visit feeling disconnected from their doctors for various reasons, while encouraging words from a familiar nurse can only foster a positive relationship and hopefully, a positive outcome.
No comments:
Post a Comment