Nursing Perspectives on Care Laurel Skinder Gourville, RN, MSN, CPNP Regis College Clinical Faculty Rosie’s Place Wellness Center November 14, 2018

How far we have come in 35 years?

Let’s first look at Mukeedah’s experience ….. https://www.youtube.com/watch?v=PU9cO_8lhwM&t=21s 

Where to start? Start where the patient is? Consider your environment….. Outreach Shelter Clinic Side walk

Assess Your Environment Is it ….. Safe? Convenient? Confidential?

Dynamics Is your establishment trusted? Are you trusted? What might you do to gain trust and rapport? Patient led priorities as much as possible Stealth skills in history…..Avoid sounding like a checklist.

Obtaining Patient history Stealth and conversational style Avoid checklist Don’t expect a full history if a guest is requesting only a Band-Aid. Work it backwards A review of medications often reflects back upon health issues.

Who is HER Person? Inquire with as much detail as possible; who this guest sees for medical and behavioral health care. Primary Behavioral Health Specialty Providers Obtain permission to communicate with any members of team Support guest in her efforts to utilize any resources her team has to offer Join any strategies that enhance success with compliance

Our Part….. Once guest is established in her specialty protocol….what can we do to support her…. Environment: Is she sheltered in any meaningful way if not, what resources may she access Basic Needs: Shelter, Nutrition, Rest, Safety, Clothing, Bathing

Medication Management

Does she really carry over 150 pills in her bag or on her person? What are her options for safe medication storage Does she have access Is she at risk for theft, diversion, loss Avoid 90 day refill offers

Options Med Planners Pre packaged dosing with proper labeling Blister Packs vs. Bottles

Screening and prevention Community Resources: https://www.mass.gov/files/documents/2018/01/09/resour ces-guide.pdf Dovetail with current substance use prevention programs, harm reduction: needle exchange, naloxone training and PREP Ubiquitous availability of condoms Vaccine Campaigns (Hep A, Hep B, Meningitis…) Review our current relationship with MAC and bi monthly testing opportunities

Are you her person too? What else can you add to the care of this guest? Simple support Don’t contradict or confuse coordination of care with specialist Acknowledge the journey Talk about something else for goodness sake, she is not defined by her diagnosis Advocate, Advocate, Advocate Seek opportunities to attain skills in therapeutic communication and healthy boundary detachment strategies

Kathy’s Journey...

Acknowledgements: Regis College School of Nursing Regis Faculty Founder: Mary Smalarz, RN, EdD Patricia Ciarleglio, RN, FNP, Anna Risman, RN, WHNP Health Care Without Walls Roseanna Means, MD Jessica Peters, MD, Ellen Matathia, RN John Schmitz, PA Boston Health Care for Homeless Program Melinda Thomas, PA Lisa Schwartz, RN, FNP Rosie’s Place Community Wellness Program Coordinator: Guisella Mariluz

Thankful……to Thank You