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Outside Thinkers Theme Stories
OUTSIDE THINKERS ALBANY COMMUNITY HEALTH CLINIC
During the dog days of 2020’s COVID-19 pandemic, a nurse-led clinic in Laramie launched a behavioral health integration program in Wyoming. And now, things are only just beginning to heat up. The Albany Community Health Clinic (ACHC) recently completed its first year of HRSA’s Nurse Education, Practice, Quality and Retention Interprofessional Collaborative Practice grant. A key component of the three-year, $1.5 million award is establishing a behavior health integration (BHI) program at ACHC, which is part of UW’s Educational Health Center of Wyoming (EHCW). Over the past year—and while powering through the delays, uncertainties and tragedies caused by COVID— ACHC’s tight-knit coalition of professionals built an adaptable BHI care model. So far, 43 patients are enrolled in the voluntary program, which encourages a patientdriven holistic care approach, integrating primary care with mental health, social work, counseling and life goals. “Our BHI program aligns perfectly with the ultimate mission of ACHC in that it seeks to serve all members of our community, including those with few resources.” says Nancy McGee, DNP, PMHNP-BC and the HRSA grant Project Director. “The program has increased access to critical mental health services in our community and is supporting our clients to engage in meaningful life changes.” Starting September 2020, ACHC hired a clinical social worker, two additional part-time PMHNPs, a medical assistant and two part-time office staff. The ACHC team, which also included a rotation of seven FWWSON DNP students, developed an inter-clinic workflow consisting of patient warm hand-offs, daily huddles, EMR modifications, monthly meetings and evolving procedural guidelines. Throughout the year, ACHC’s BHI team also consulted with Community Health Center’s Weitzman Institute, led sessions of Wyoming Project ECHO, and trained in Solution-Focused Brief Therapy. Results of the clinic’s year-one grant work are enhancing the connection, communication and collaboration among the nursing staff and care providers, and ultimately providing a customizable, patient-centered care model. Each BHI patient’s care team consists of, at the least, a
Nancy McGee, DNP, APRN-BC Clinical Associate Professor / Project Director for ACHC As the project director, I am really impressed by each team member’s willingness to expand their comfort zones and reconsider a new model of care. This team is more flexible and supportive of innovation than any group I have worked with previously. The BHI program fits so nicely into the ultimate mission of our clinic—because we seek to serve all members of our community, even those with few resources. Behavioral Health Integration at ACHC has increased access to critical mental health services in our community and is supporting our clients to engage in meaningful life changes.”
J’Laine Proctor, FNP, PMHNP, DNP Clinical Associate Professor (HRSA Grant’s Clinical Director)
primary care provider, behavioral health coordinator, psychiatric nurse practitioner and an RN clinical case manager. Once enrolled in the BHI program, patients work with their support team to identify self-management goals to address physical or emotional wellness. The possibilities for these goals are endless, and it is up to the client to identify areas in their life where small changes can make meaningful differences. Clients select BHI goals such as improved time-management, budgeting, exercise, increased socialization, nutrition and finding new hobbies. According to client feedback, the most meaningful impact of the BHI program is not always the behavior change, but the regular check-ins by the nursing staff, who call patients to ask about their progress and how the BHI team can support them. This was especially a highlight during the pandemic, when many in the community struggled with social isolation. The BHI program was able to provide supportive connections with some of the community’s most vulnerable patients. “Not only has this process allowed us as nursing staff to connect on a different level with our patients, it provides us a unique opportunity to work at the top of licensure and take upper-level ownership in patient care,” says Katie Doherty, RN, ACHC Nursing Supervisor and Interim Clinic Director. BHI patients also share that they feel more genuinely supported than they have with traditional care. The added care, along with accountability, has helped clients achieve sometimes small but often significant lifestyle changes, contributing to the overall wellness of the BHI patients. Led by the HRSA grant’s Clinical Director J’Laine “Jill” Proctor, DNP, FNP, PMHNP, year two of the grant-funded work will focus on expanding mental health telehealth services to Wyoming’s underserved patients in Carbon, Fremont and Laramie Counties. Proctor and the clinic’s BHI team will also incorporate medication-assisted treatment into the ACHC portfolio of patient care. “We’re excited for the second year of the grant, when we will share our successful model and services with other underserved communities in Wyoming. We believe that everyone should have access to quality mental health care and are hopeful that we can bridge some of the critical care gaps throughout Wyoming,” says Proctor. All the while, the clinic and its nurse practitioners will continue to pursue the mission of both EHCW and the HRSA grant by training more of Wyoming’s DNP, MS and RN nursing students.
Students and alumna benefitting from working with Albany Community Health Clinic include: Pictured below: (l-r) Eric Gillies, DNP-FNP student; Raegan Kartupelis, DNP-PMHNP student; Jaycie Till, BRAND student; Jamie Smiertelny, MS Social Work student; and Samantha Reed, DNP-PMHNP 2021 alumna.
OUTSIDE THINKERS
INTEGRATIVE CARE WITH MCMURRY FUNDING
Dr. Sherra St Clair McMurry Chair in Mental Health
Dr. Sherra St Clair accepts position as the new McMurry Chair of Mental Health at UWFWWSON
Dr. Sherra St Clair has accepted a position as the new McMurry Chair of Mental Health at the UW FWWSON. St Clair will provide oversight to the integration of mental health into care delivery across nursing programs at UW. In this new position St Clair will focus on education and practice to increase the quality and quantity of psychiatric mental health practices into care delivery. To accomplish this mission, she will be working with other faculty across programs in UW Nursing. She also will be collaborating with key stakeholders around Wyoming to identify and assist in implementing best practices. Sherra is a board-certified Psychiatric Mental Health Doctor of Nursing Practice (PDN, PMHNP) and Clinical Assistant Professor at UW FWWSON. She has four years of inpatient psychiatric nursing experience, and two years of outpatient experience as a DNP working with mental illness, suicide ideation / attempts, substance abuse and withdrawal. She practices patient care at Healthworks, a Federally Qualified Health Center (FQHC) in Cheyenne, Wyoming, and teaches courses for the University of Wyoming Doctor of Nursing Practice (DNP) and Basic Bachelor of Science in Nursing (BSN) programs.
St Clair’s primary role as a full-time faculty member is statewide service and community engagement. Sherra is passionate about addressing stigma and bias and improving access and resources for mental health in Wyoming. St Clair is eager to engage in communications with the many professionals whose influence is integral to her focus. Please join her in this important work: Dr. Sherra St Clair’s email: sseifert@uwyo.edu / office phone: 307-766-5402
ECHO Program to be utilized
St Clair is deeply invested in expanding UW’s Integrative Care Network through Project ECHO program. ECHO is a revolutionary model led by experts, providing free online medical education clinics for individuals, families, educators, case managers, administrators, and healthcare providers.
St Clair’s background
St Clair entered the nursing field after twenty years as a Masters-prepared medical illustrator, where she created highly detailed, accurate illustrations and animations to teach healthcare providers and patients about medical procedures, anatomy, physiology, pathology, trauma, and surgery.
Sherra displays a piece of her artwork.
Dr. Janet Willhaus receives McMurry grant for her subject, “Exploring the impact of aromatherapy and three-dimensional guided visualization on anxiety”
An interesting piece of research by faculty member Janet Willhaus has been utilizing the University of Wyoming Shell 3D Visualization Center (“Viz Center”), lending access to virtual reality (VR) and other emerging computer technologies. Willhaus has been concerned about anxiety on the rise in the United States and that it is impacting young adults at higher rates than the general population. Text anxiety, writes Willhaus, “impacts significant numbers of undergraduate students,” so Willhaus made some research plans, knowing that “Aroma therapy, mindfulness, and guided visualization have been used successfully to treat various forms of anxiety including test anxiety.” Willhaus writes, “The University of Wyoming Shell 3D Viz Center has the capability of recording and creating three dimensional (3D) visual experiences of peaceful Wyoming natural vistas meant for viewing through a 3D headset as a virtual reality experience. Such a recording will be combined with an auditory relaxation guide and aromatherapy experience in an attempt to discover whether smell/aroma can be used as both a later reminder of the exercise and a measure to reduce anxiety.” A sample of approximately 100 students with test anxiety have been recruited, consented, and randomized for a proof of concept study.
Janet Willhaus Research story continued on pg. 8
Willhaus in VizCenter Simulation
Janet Willhaus wears the 3D headset as she works through simulations for her research, while Phil Black, Research Scientist, Asst., at the Shell 3D Visualization Center, looks on after preparing the equipment for Willhaus.
OUTSIDE THINKERS
IMPACT OF AROMATHERAPY & 3-D GUIDED VISUALIZATION ON ANXIETY – JANET WILLHAUS RESEARCH CONTINUED FROM PG. 7
Each student will be asked to identify a date of an upcoming anxiety-provoking exam. Groups will receive either no intervention, 3D experience with auditory relaxation guide, 3D experience with auditory relaxation guide and aromatherapy, or aromatherapy alone. On the day of the test students will be contacted via text, asked to recall the visualization experience and/or apply the aromatherapy tab as appropriate and then complete an anxiety scale via Qualtrics survey before and after the test. Results will be analyzed using a one way ANOVA. If differences are detected between treatment groups, techniques could be adapted to provide relief for other types of anxiety beyond test anxiety outside the university setting. The visualization experience could be adapted for home use using commercially available 3D headsets and a computer using a cell phone and an inexpensive cardboard viewer.
AUDIO FIDELITY
Willhaus and Gable Awarded Humenick Funds for Audio Fidelity Project
Simulation plays an important role for nursing student education each year and many aspects of simulation pedagogy remain unexplored. Audio fidelity (the realism of the voices and noises during a simulation scenario) can be either a distraction or a contributor to learning during a simulation scenario, however, little research currently exists on this phenomenon. Researcher Janet Willhaus and Simulation Director Denise Gable will explore whether Audio Fidelity has an impact on student perceptions or learning. The research is funded by an award of up to $1,500 from the 2020 Humenick funds to purchase equipment that can change the tenor of a facilitator’s voice to match the expected age and gender of the simulated high-fidelity patient. Students will complete surveys and their pre and post simulation quiz scores will be compared to determine whether differences in learning exist between scenarios with and without audio fidelity.
l-r: UW Nursing Clinical Simulation Center Coordinator Denise Gable, MPA, CHSOS; and UW Assistant Dean, faculty member and researcher Janet Willhaus, PhD, RN, CHSE, CHSOS
CHSOS CERTIFICATION OUTSIDETHINKERS
Willhaus and Gable among the few in the nation with CHSOS Certification
Simulation has made a huge difference in education, especially during the pandemic. The UW FWWSON is grateful to have two individuals on our faculty/staff team who are simulation experts. Janet Willhaus completed her renewal for her Certified Healthcare Simulation Operations Specialist (CHSOS) in April of this year. She says she has been continuously certified in Simulation Operations since 2018 and continuously certified in Simulation Education (CHSE) since 2014. And in 2021, staff member and Clinical Simulations Center Coordinator Denise Gable earned her operations certification (CHSOS) as well. This is a big deal. CHSOS IS AN INDICATOR of expertise in how to run simulations and how to run a simulation program. Willhaus comments, “Only a handful of people in the country meet these requirements.” And UWFWWSON has TWO individuals currently certified and rocking our simulation world!
Why should students and future
students care? Willhaus continues, “CHSE means you have expertise as the educational aspect of simulation. Both [CHSOS and CHSE certifications] are important to make sure our learners get the most learning and value in a simulation. Just like we ensure clinical sites meet high standards, certification in simulation (both kinds) helps us make sure our program meets high standards.”
What makes it difficult to pass?
According to the SSIH website (www.ssih.org/Credentialing/ Certification/CHSOS/Eligibility), in order to be eligible to sit for the exam, one must… • participate in healthcare simulation in an operations specialist role • demonstrate focused simulation expertise with learners in undergraduate, graduate, allied health, or healthcare practitioners • possess a bachelor’s degree or equivalent combination of education and experience • document two-years of experience in a healthcare simulation operations role
As far as what it took for me (personally) to pass the exam”, says Gable, “I logged over 100 hours of professional development last year (webinars, seminars, meetings, conferences, courses). I also spent hours of time reading books, forums and websites in order to study for the exam, which is a 2-hour computer exam.” The certification must be renewed every three years.
