Week 12 725C Blog Post

Review in detail your service-learning site:

Where are you serving?

I am doing my service learning at Providence Benedictine Nursing Center.  This nursing center is located in Mt. Angel, Oregon.  This is a rural farming community 15 miles east of the state capital.  The Sisters of Benedictine started a nursing home in Mt. Angel in 1955 in a house in the community.  In 1957 they broke ground on the building that currently is Providence Benedictine Nursing Center.  In 1998 the Sisters of Benedictine and the Sisters of Providence agreed that the Providence Health System would be a good organization to run the nursing home moving forward and Providence Health bought the nursing center.  The Sisters of Benedictine live next door at their monastery and frequently visit residents in the nursing center. 

What does the agency do?

Providence Benedictine is a 98-bed long-term care facility.  36 of the 98 beds are dedicated to post-acute rehab and do not service long-term care patients.  The campus cares for the elderly population via their long-term care services, post-acute rehab services as well as home health, hospice, and assisted living services.  Providence Benedictine is also active in the community of Mt. Angel. 

Who are the clients and what needs are served?

The clients are the elderly population of primarily Marion County.  However clients can and do come from other county’s in Oregon.  This campus also serves underserved and impoverished elderly clients.  They accept Medicare and Medicaid and also have a charitable foundation to help offset costs of care for those who cannot afford it. The needs that are served range from in home care, hospice care, long-term care, assisted living care, and post-acute rehab. 

What is the agency funding support?

Providence Benedictine has multiple payers to include Medicare, Medicaid, Keiser Permanente, and the Providence Health Plan.  This facility also has a foundation that raises money to offset the cost of care, constructions, equipment costs, and other financial needs that may arise.

I have spent 20 hours of service learning at Providence Benedictine this semester.  I have been working with the residents on a garden project.  We are converting one of the cement patios into an outdoor garden so that residents can access the garden and be able to enjoy going outside. There will be a covered potion to the garden with the final project.  Residents drive the formation of the garden and need man power to bring it to fruition. 

What roles do DNPs play in promoting health and wellness in underserved?  I believe that my role as a DNP in this project will continue to be a role model for staff.  It shows them that we can think outside the box and confines of our “jobs” and reach people on a different level. 

How do you perceive your individual role in this?   I plan to see this project through to the end, which means once I have completed the DNP program my service learning will continue.  I believe that service learning is one way a DNP can provide health and wellness to the underserved in the community. 

What was the best/worst/most challenging thing that happened this semester? (DEAL Model format)

Describe: The worst thing by far that happened this semester was the violent death of a 25 year head nurse at Benedictine.  It was so senseless and has left us with a very big whole in our hearts. 

Examine:  This nurse was the epitome of a servant leader.  She lived her life to serve others and showed God’s love to all.  This has been so hard for the staff to come to grips with and people are still in varies stages of grief. 

Articulate the Learning:  I have learned about love for others through this tragedy.  It is literally so unimaginable to me and I have seen the strength of family at work in action.  Everyone grieves in their own way and you have to meet people where they are to help them find some sense to be able to move forward. 

Tracy 

725B Service Learning Post Week 12

Review in detail your service-learning site:

-       Where are you serving?

o   I am doing my service learning at Providence Benedictine Nursing Center.  This nursing center is located in Mt. Angel, Oregon.  This is a rural farming community 15 miles east of the state capital.  The Sisters of Benedictine started a nursing home in Mt. Angel in 1955 in a house in the community.  In 1957 they broke ground on the building that currently is Providence Benedictine Nursing Center.  In 1998 the Sisters of Benedictine and the Sisters of Providence agreed that the Providence Health System would be a good organization to run the nursing home moving forward and Providence Health bought the nursing center.  The Sisters of Benedictine live next door at their monastery and frequently visit residents in the nursing center. 

-       What does the agency do?

o   Providence Benedictine is a 98-bed long-term care facility.  36 of the 98 beds are dedicated to post-acute rehab and do not service long-term care patients.  The campus cares for the elderly population via their long-term care services, post-acute rehab services as well as home health, hospice, and assisted living services.  Providence Benedictine is also active in the community of Mt. Angel. 

-       Who are the clients and what needs are served?

o   The clients are the elderly population of primarily Marion County.  However clients can and do come from other county’s in Oregon.  This campus also serves underserved and impoverished elderly clients.  They accept Medicare and Medicaid and also have a charitable foundation to help offset costs of care for those who cannot afford it. 

o   The needs that are served range from in home care, hospice care, long-term care, assisted living care, and post-acute rehab. 

-       What is the agency funding support?

o   Providence Benedictine has multiple payers to include Medicare, Medicaid, Keiser Permanente, and the Providence Health Plan.  This facility also has a foundation that raises money to offset the cost of care, constructions, equipment costs, and other financial needs that may arise.

-       Service Learning Hours

o   I have spent 10 hours of service learning at Providence Benedictine this semester so far.  I have participated in the facilitation of activities for residents on Harmony Lane (one of the long-term care units).  One of the main activities I was involved in this semester was the resident driven bingo game.  The residents needed a space they could consistently hold their own bingo game and I worked with the residents and staff to find a suitable space for bingo. I have also spent time serving a resident that needed problem solving done in regards to space/room/furniture issues. (see below reflection) 

What roles do DNPs play in promoting health and wellness in underserved?  How do you perceive your individual role in this?

-         I feel that the role of the DNP in promoting health and wellness in underserved populations is to ensure that you are up to date on practice, best practice and community resources.  This will enable the DNP to provide up to date knowledge and resources to the underserved populations.  At Benedictine the underserved population are the residents in the long-term care units.  There may be a perception that health and wellness does not matter in this population.  One of the focuses of my PICO project is to ensure that staff realize it does matter in this population.  Health and wellness activities can increase the quality of life in this elderly population and should be offered.  As a DNP I can help make this happen by finding out what the residents would like to see offered and find out what they are interested in (such as gardening, walks outside, etc.).  I can be the driver to this change for the residents. 

I 

      I think one of the key roles of the DNP in any setting is being the leader and driver of change.  Healthcare in all settings is changing daily and we must be able to keep up with that change and even be prepared so that we are ahead of that change.  

I

What was the best/worst/most challenging thing that happened this semester? (DEAL Model format)

-          Describe: I feel that the worse and most challenging  thing that happened this semester was the death of one of the long-time residents in the nursing center.  It came as a surprise to staff and it was hard for them and myself to deal with.

-         Examine: This particular resident fit into the vulnerable population because the diagnosis put this resident into a disabled category.  I was able to get to know this resident very well and glean knowledge from this person that will help the person-centered care model move forward in the nursing center.  This resident was of sound mind and younger then the average population in the nursing center.  I think that is why it was hard on staff and myself when we heard the resident had died unexpectedly in the hospital.  I feel that my work with this person was very valuable and I appreciate the time I had with them.  It was an honor to work with and serve this resident.  I was able to problem solve some furniture/room/space issues that the resident had and find a very pleasing option to the resident for storage of personal items that needed to be locked but accessible to the resident.  That is not always easy to do when there are no funds available. 

-          Articulate the Learning: The learning for me in this above situation was that creative thinking and thinking outside the box may take some time and effort but it is well worth it in the end to have a positive outcome for a person that has a need.  It is very fulfilling to be able to help someone meet a care need or personal need.  The staff at Benedictine are really amazing.  When this resident passed they pulled together as a family and supported each other.  I will take this experience with me as I move into the final pre-implementation phases of my project and apply that family like atmosphere to the person-centered care model.  I feel that the Interprofessional collaboration among staff was excellent.  This did not just involve the nursing staff.  It involved staff from all areas of the nursing center as this resident touched many people’s lives and disciplines during their stay at Benedictine.   

This experience was definitely the worst and most challenging thing that I’ve dealt with this semester but I can also view it as the best thing that happened.  It was a blessing to know this resident and get to problem solve with the resident and know that I made a positive difference in this persons life.  It was also a blessing to see the collaboration of staff and how they came together not as co-workers but as a family in their time of lose. 

Tracy 

March 22nd Post:  How would you describe in detail your service learning site? My service learning site is a 98-bed long-term care nursing facility.  The Sisters of Benedictine started it in the community of Mt. Angel, Oregon in 1955. The current building broke ground on 1957 and the home was purchased by Providence Health and Services in 1998.  
◦ Where are you serving? Providence Benedictine Nursing Center 
◦ What does the agency do? Provides aging services 
◦ Who are the clients and what needs are served? The “clients” are the 24 residents that currently reside on a long-term care nursing unit.  The needs served are: engaging them in conversations about their well being, who they were before coming to the home, who they are now, and how we can best serve them on a day-to-day basis.  
◦ What is the agency funding support? Medicare, Medicaid, private insurance, private pay, and foundation dollars. 
• What is it about the community partner that calls you to work with them?  I think it really important to serve the underserved.  This is part of the Providence mission.  People do not grow up wanting to live out their last days in a nursing home.  I want to give them a sense of “home” because that’s what they deserve.  
◦ Why are you engaged with this agency? Providence is a mission based Catholic organization that upholds the teaching of Christ.  This is why I came to Providence.  
◦ What is your passion here? My passion is to serve the underserved.  I want to improve quality of care and ensure that these people are seen as people and are treated with respect. I want the staff to really know who they are taking care.  
• What are you currently doing with this organization and how do you see it evolving as you sustain your commitment with them?  I am currently working on my capstone project.  This entails implementation of a person-centered care model of nursing on one of the long-term care units.  I hope to expand this model through out the building and show how it can be replicated and sustained.  
◦ What is your role in this service learning experience? My role is to head up my capstone project.  I work with my mentor who is the resistant care manager on the unit very closely.  
◦ What hours did you spend at the site and what activities were performed? Clinical hours I've spent here are 185 hours.  Within those hours I've spent 15 service learning hours.  I've spent time in one-on-one conversations with the residents to find out how we can better serve their needs and what thier wishes are for self-directed care.  I think the time I've spent with the residents has lended itself to servinvg them as a companion as many of them do not have family that come and visit.  I help take them to activities and at meal time as well (for those that need assistance eating).  It has been very humbling to get to know these residents and find out what lives they lived prior to coming to Providence Benedictine.  
◦ What are the opportunities there? The opportunities here are: improving the bathing process (there is money available that no one has put to use- it was designated by a donor specifically for the shower room), improving the care model delivery from a medical model to a person-centered care model.  Providing a volunteer companion to sit and talk to with the residents as a part of their weekly routine.  
◦ What can you see yourself doing more long-term? I see myself staying involved long-term for the sustainability of the new nursing model of care.  In the literature reviews I’ve done I have found that person-centered care must be “kept up” or care models can slip back to post-implementation models.  
• Are people you came in contact with through this experience having some needs met through the community activities? Yes.  I think the staff and residents have already had needs met.  They have a sister-nursing center in Seattle that was able to successfully implement person-centered care and they strive to replicate that success.  They are excited about the upcoming change.  The community activities would be the informational  question and answer staff forums.  Also the involvement in the acitivites and mealtime process.  I think by getting to know the residents better I can help the staff know them better as well.  
• Are community activities like these necessary and/or sufficient to fulfill these community and individual needs? I think the forums are necessary because staff feedback is vital. Resident feedback is also vital.  
• Do you see other means to do so? Yes.  Staff could be interviewed one-on-one or surveyed.  
◦ What was the best/worst/most challenging thing that happened this semester? I think the most challenging thing that has happened this semester was hitting the ground running.  It was hard to balance three classes, life, and work.  It was also hard to get people talking about the change that needed to happen.  I think the best thing thus far is the reception of staff I have for my capstone project.  I have also been invited to Seattle to spend a day at Providence Mt. Saint Vincent to see how their person-centered care model works.  I am going on Tuesday March  25th.  
◦ What have you learned about yourself? I have learned that I need to take better care of myself and not try to get everything done at once.  I have learned that this is a process that will take time and deserves the time I give it.  
What are your future service learning plans? My future service learing plans are to continue to serve Providence Benedictine in other aspects of care delivery.  I want to ensure that the residents and staff needs are being met.  I want to be able to help them through challenges of care delivery change and help them see that they can make a difference in each others lives as well as the community.  

Person Centered Care Entry One

This blog will be dedicated to my capstone project of implementation of a person-centered care model in a long-term care facility.  This project focuses on the "normal" choices of life such as when to eat, bathe, sleep ect.  It gives residents the choice in their current enviroment.  The goals are to improve quality of life and care.  The goals in regards to staff are to improve job satisfaction with care provided.  It's exciting and needed.  My mentor has been a gerontology nurse for 20+ years and has a passion for this much needed implementation.  I am looking forward to the process.  Thank You

Tracy Thompson