Sabbatical Awards 2005-2006

Sabbatical Report:  Nadine Wilkes

Lane Community College Health Clinic 

Purpose:

1. To research, outside of Lane Community College, more efficient teaching models for patients’ health problems, especially chronic health conditions
2. To learn “full loop” spirometry
3. To develop improved patient teaching aids

My reasons for these activities include:

1. A need to streamline our resources (budget cuts!)
2. I needed to update my nursing skills, especially in the areas of diabetes and asthma.  We are diagnosing and treating these conditions with increasing frequency and the field is changing rapidly.  Our patients deserve state of the art care.
3. I needed more education as an instructor.  As the clinic needs have changed I have been spending more time teaching in the classrooms and in the clinic, as well as precepting nursing students.
4. To observe best practices and integrate new ideas into my patient care.

This activity is valuable to the college in the following ways:

1. When I started working at Student Health in 1993, we mostly treated acute conditions for students.  Over the last year, we have evolved into the Lane Health Clinic.  Our demographic and expectations changed when we began to serve employees.  Last year approximately 40% of my patients were LCC employees.   We are diagnosing and treating many more conditions that are chronic.  In our clinic, the majority of our patients are evaluated and treated by Family Nurse Practitioners or myself (a Registered Nurse).  I work under extensive standing orders developed by our Medical Director and myself.  My evaluation and treatment skills need to be very current because of my practice.  Most are honed with on the job training and seminars that can be “worked in” to my very inflexible clinic hours.  I felt that more formal training was necessary to appropriately evaluate and treat these potentially life threatening conditions.
2. The addition of employees to our patient base requires increased efficiency.  Although our potential for seeing many more patients has increased, our FTE has remained essentially constant.  By learning techniques employed by community health educators, I can improve the efficiency of patient teaching.  These methods should also increase the ability to measure patient outcomes.  I will be looking for continuous quality improvement.  Our numbers of patients treated will increase if the methods are more efficient. 

What I did:

1. I purchased a laptop computer and learned how to use it.  I am developing my PowerPoint skills for class presentations.
2. Although it was not one of my goals, I nominated the Health Clinic for a League for Innovation in Community Colleges Innovation of the Year Award.  We were awarded an Innovation of the Year Award later in the spring.
3. I attended a workshop on diabetes, pre-diabetes, and the relationship to “metabolic syndrome”.  With this knowledge I have developed an improved lecture for use in employee and student groups. 
4. I learned to perform full loop spirometry, and have practiced using it on our clinic spirometer.  I performed several of these enhanced tests in the clinic during spring term.  I am the sole practitioner in the clinic who is trained in this pulmonary function test.  I was able to test for asthma in the past.  Now I will be able to evaluate patients for chronic obstructive pulmonary disease as well.
5. I visited several colleges and met with clinic staff and health educators in order to determine best methods for teaching pathophysiology, disease management and lifestyle changes.  The LCC Clinic is hard to compare to others.  We are the only one of its kind in Oregon.  I visited a variety of settings to see how the clinics were run, what health problems were addressed, and how peer educators were used as a resource.  I was especially interested in the peer educators.  We have a host of health occupation students here.  Why not provide an alternative clinical experience for them, as well as use their skills and energy to assist in our clinic?  What subjects do they teach in other schools?  What kind of training do they receive?  How do they get paid?  Could nursing students assist us in immunization clinics?  What about a student webmaster to put information on our website?  This could be a win-win situation for all of us.

The schools:

1. The University of Oregon

I visited the travel clinic.  By special arrangement, we are able to refer patients to the UO travel clinic.  I wanted to see the clinic, meet the staff, and be able to work more closely with them.  Could we better prepare our students?  It is a very comprehensive service.  I was given some of their patient handouts.  I met with the health education, and peer educator coordinators.  They gave me their training information, as well as resources from their health educator.  They are able to obtain a number of grants because of their large university status.  Could we tap into the grant money?  I would like to look into the possibility. I visited the allergy, asthma, and nurse clinics, and we exchanged informational templates.  The Clinic Director, Ann Matson planned an incredible learning day for me. 

  2. Southern Oregon University

The SOU Student Health is similar in size and function to ours.  I met with their Director, Diane Potratz.  We exchanged ideas on improving patient flow.  They use nursing students for immunization clinics and masters’ students for other projects.  Their peer educators are part of the Women’s Center, and deal primarily with campus social issues.  Diane gave me many resources which I spent perusing when I returned home.  They sell over the counter health items there.  The clinic makes a profit, and the students can purchase the items for less money than the retail markets.  We could do this easily.  They have a nurse clinic as well.  This may be a way to evaluate more patients with existing resources.

  3.  UC Davis

I was especially interested in the health promotion and peer education programs of the Cowell Health Center.  Michelle Johnston, the Director, was a wealth of information and resources.  She has a dynamic and creative team participating in health and safety education in many areas of campus life.  I was given access to many of their resources including health-e-messaging, internet , and college health literature.  They gave me ideas for games, and copies of their health promotion materials.  The peer educators there are paid with a notation on their transcripts and a letter of recommendation.  I was told that in the highly competitive school and job market, these positions are actively sought because of the transcript note.    This may work for us!  They have comprehensive links to their website.  We need to expand ours.  I also visited their employee health service.  The services they offer are not similar to ours.  They do integrate employee wellness activities into campus wide events.

4.  Stanford University

The Vaden Health Center is comprehensive, and so well funded that we could only dream of some of their services.  The Director of Health Promotion Services, Kate Bedford, was very helpful to me.  She helped me to realize that we may be money poor, but we have less bureaucracy to wade through to make changes. She gave me good advice about where to start with a new program.  They have a very comprehensive and professional peer education program.  They mostly perform sex and health education functions, and work on campus safety and social norming events. 

5. Humboldt State University

The Student Health Center there is not similar to ours.  It was nice to see, but there were few services that I could compare.

6. Yale

Yale University Health Services has a fabulous newsletter and comprehensive web links.  I am going to use many of the same.  I would like to develop a newsletter with seasonal topics.  This would be a great student driven project. 

1. I evaluated the information that I had collected.  What would work for us?  What could we alter in order for it to work?  I see huge potential for peer educators.  We could start small, and develop slowly as we put the recruiting and teaching elements into place.  I updated some of our patient teaching handouts.  I would like to put all of these on our website, as well as our medical history form.  This will facilitate more efficient patient care.  I explored the many resources from the different universities. It took much longer than I thought to wade through all of the information given to me. 
2. I worked through the PowerPoint tutorial, and learned some rudimentary skills.  I have wanted to improve a few of my lectures, so:
1. I added pictures to my sex education class
2. I reorganized the metabolic syndrome lecture
3. And developed a diabetes lecture that stresses early intervention and lifestyle changes.
3. I wrote a curriculum for an aging parent class. I believe there is a great need for this class.  I have arranged guest speakers and have materials for ten hours of lecture.
4. I reviewed and evaluated informational web links for our clients.

I appreciate the opportunity to work on these projects.  I hope that the college will benefit from them.