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

2. How far we have come in 35 years?

3. Let’s first look at Mukeedah’s experience …..

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

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

6. 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.

7. 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.

8. 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

9. 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

10. Medication Management

11. 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

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

13. Screening and prevention
Community Resources:
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

14. 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

15. Kathy’s Journey...

16. 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

17. Thankful……to
Thank You