  | URI's nursing practitioners offer care and compassion to the neediest patients. | ||||||||
Clinical OverloadBy Chris Poon They hobble into the health clinic looking for help, but not always of the medical kind. Some of the elderly or disabled residents living in the Providence Housing Authority's apartments are distraught about eviction notices, confusing bills, or even a psychologically crippling phantom menace. Sure, they need someone to explain that they must take their blood pressure pills daily, not just when they feel weak. They need someone to write them a prescription, or find them a dentist, doctor, or psychiatrist. But they also need a patient listener to help carry their burdens, if for only a half an hour. The folks on the medical front line for the 1,130 residents are with URI's Primary Health Care Nurse Practitioner Program. The clinical professors and students who staff the walk-in clinics operate on one guiding principle: medical expertise is nothing if it is delivered without care and compassion for a patient's physical, psychological, social, and sometimes spiritual needs. "You can't come up with a recipe for the elderly or disabled. If you don't take the time, you don't get anywhere with these folks," says Anna F. Fulton, M.S. '85, a registered nurse practitioner and URI clinical assistant professor who oversees the students on their clinical rotations at the Providence Housing Authority. The housing authority has seven residences throughout the city for low-income elderly or disabled people. Almost half of the residents do not have adequate health insurance, if any at all, and many of the disabled suffer from serious mental illnesses, said Fred Sneesby, the housing authority's supportive services manager. "What Anna offers to people, along with the URI students, is she's reaching out to people who need medical care," Sneesby said. "Whenever they get a lead, they knock on doors and find people. Sometimes [the residents] are hostile or indifferent. Most of the time, people are receptive once they find out there's nothing to be afraid of." The URI health clinic program, called Housing Helps, is funded with an $80,000 U.S. Housing and Urban Development grant. Fulton staffs the clinics, which are also the training ground for undergraduate nursing students as well as graduate students enrolled in the Nurse Practitioner Program. For some students, the clinical experience gives them their first opportunities to work with elderly patients. For graduate student Mary-Beth Welesko '01 of North Kingstown, the weekly rotations in Providence allowed her more time to specialize in geriatric medicine, an area she loved while working as a registered nurse. Welesko is one of about 50 students who are enrolled at any one time in the graduate Nurse Practitioner Program each year because they want to take their nursing training to a higher, more independent level. Nurse practitioners certified by the state can assess patients more thoroughly, diagnose problems, plan a course of treatment, and write prescriptions. "When you go in as an R.N., you're seeing how the patient is doing, how they're managing with the plan or medications the doctor has set. As a nurse practitioner, you're doing the same by assessing the environment and physical things, but now you're assessing your own plan: What would I do to change the medications if I need to? What other services should be added?" Welesko said. "I really like that role." The advanced skills taught in the Nurse Practitioner Program--the only one offered in Rhode Island--make the program a very popular one for career nurses, said College of Nursing Dean Dayle Joseph, M.S. '76. "Nurse practitioners are very interested in their practice and in changing the way health care is delivered," Joseph said, noting how URI's nurse practitioners-in-training are working with the homeless at Traveler's Aid Society shelter and at the Rhode Island Free Clinic, both of which are in Providence. "They do that sort of outreach, which I believe is extremely important for our college, and for people in general." The two-year Nurse Practitioner Program not only requires students to work in various settings--from pedia-trician's offices to women's clinics--it also tries to place students in areas they want to specialize in, said Denise Coppa '72, the program's director and a clinical assistant professor of nursing. After all, it's not just what the students learn from their professors that will make them competent nurse practitioners, Coppa said. "I've always loved the clinical setting. Nurse practitioners help people make their own decisions. We kind of facilitate their wellness. We don't impose things for the most part." Fulton agrees. She calls the housing authority's Housing Helps medical clinic "very nitty gritty" field work for students. "I try to take the students where the patients are and give them experiences so they can grow," she said. "I don't have them just do blood pressure checks. I want them to address problems as I might." For Fulton, that may mean finding help for an elderly man whose daughter committed suicide, connecting residents who don't have health insurance with clinics that can serve them, or checking residents' refrigerators to make sure they are preparing healthy meals. Sneesby, of the Providence Housing Authority, says the weekly "sick calls" Fulton and her staff schedule have proven to be lifesavers for his residents. "There's probably about 150 to 200 people who have gotten direct medical care or medical case management who would not have if this program didn't exist," said Sneesby of the program URI began in November 2000. "It's been a great addition to the services for people here. We'd like to see the relationship with URI expanded." Mary-Beth Welesko says her clinical rotation at the Providence Housing Authority reaffirms her decision to work with the elderly in a community health setting. "I think it is unique in its own way because you're down where people live, you're down at their level, you're accepted into their lives," says the married mother of two teenagers. "There's more of a closeness with the residents that's just developing." Chris Poon is a graduate student in URI's School of Education. She is pursuing a second career in elementary education after working as a newspaper reporter, most recently at The Providence Journal. She lives with her husband and two daughters in Wakefield, R.I. |
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