- Associated Press - Saturday, November 1, 2014

GILLETTE, Wyo. (AP) - He lay there in his hospital bed, wheezing and blinking through his catatonic state. It was apparent he had been there for a while. Not moving. Not speaking. A husk of a man on display.

Several nurses had been in to check on him throughout the morning. The questions they asked John Smith were always the same.

“Do you know what day it is?”

The nurses would start at his head and work their way down. They checked his scalp, his eye movements and his pulse. They listened to his lungs and checked his airway. They listened for bowel sounds.

“Do you know where you are?”

He’s bedridden with a systolic heart murmur, pneumonia in the lower lobe of his left lung and a hypoactive bowel. He has a puss-oozing cut on his left foot, infected from a wound left untreated for too long.

His hair is filled with lice, his teeth ground to stumps. As Heather Folda, 22, flips him onto his side to listen to the sound of his crackling lungs, Smith’s disheveled salt-and-pepper hair falls to the floor.

“Let’s put your hair back on, Mr. Smith,” Folda said, stifling a laugh.

“You need to brush your teeth,” Shelby Smiley whispered a few minutes later during an examination of Smith’s mouth.

The nurses weren’t being callous. It’s hard to care for a machine, Smiley said.

“I would just rather have a real person because I think it’s so hard,” she said.

Smith, a dummy made up with moulage and fixed with certain ailments, is the first patient for the next generation of health care professionals.

In Gillette College’s nursing program, these scenarios are common. It gets better with time, but it’s still awkward, Folda said.

“I took a CNA class here this summer and they taught us right away to talk to the patient like it’s a real person,” she said. “It doesn’t really phase me that much.”

What sounds like playing doctor with glorified dolls is actually a great way to prepare tomorrow’s nurses for what they may encounter, said instructor Julie Guernsey.

Smith can be programmed with heart, lung and abdomen sounds. He can also talk during a full scenario - or cry out with pain during an assessment, Guernsey said.

“It’s all about preparation,” she said.

In a country facing the potential of an Ebola epidemic, there’s no such thing as too much preparation.

Like health care systems across the nation, Campbell County Health updates its physicians, nurses and technicians each day on Ebola protocol passed down from the Centers For Disease Control and Prevention.

The disease is new to the U.S. - the first case diagnosed in the country came Sept. 30 - but already CCH is putting together a plan. An emergency response team is in the works, recruiting health care professionals willing to treat patients if and when the disease should come to the area.

“At first we are asking staff - nurses, lab people, radiology, physicians - to volunteer because it’s a pretty serious commitment,” said Veronica Taylor, CCH infection prevention specialist. “I believe our staff would be safe; however, it’s a pretty big commitment to say that you would care for a patient with that disease.”

Health care workers around the country have handled in-country patients very well, she said.

Of the more than 70 people in Dallas who cared for Thomas Duncan, the first patient diagnosed with Ebola within the United States, only two became ill.

Both infected nurses tested positive for Ebola earlier this month, but have since been cleared. One was released from the hospital Friday, the other is expected to be released early next week.

Smiley, 23, said she doesn’t know what she would say if asked to volunteer. She said she has a cousin working at Campbell County Memorial Hospital who was asked.

“She had to straight up say, ‘No, I would probably have to isolate myself,’” Smiley said. “She has a little boy, and she’s a single parent. She said she just can’t risk that and risk his life. In her case, it has nothing to do with wanting to help the patient. You have to prioritize.”

For Folda, risk is a part of the job.

“I think in nursing, you try not to get scared of things like (Ebola) - you just do your job,” she said. “You want to protect yourself, but we’re there to help the patients and protect them as well. It’s like a balancing scale.”

There are 59 students enrolled in Gillette College’s two-year nursing program - 30 first-year students and 29 second-year students

“It starts out very foundational. Then as students progress through the program, it becomes more difficult,” said Louise Posten, program director.

During their first year, students learn the importance of communication, both with patients and their fellow health care providers, Posten said. In their second year, the program focuses on management skills every nurse will need.

“We go over legislative issues in nursing, or just in health care in general - current trends, anything that’s going on,” Posten said. “We have some discussions and some content that tries to cover anything contemporary that’s going on in the health care field at that time.”

But preparation is more than just learning from a textbook, she said. In a world facing widespread health hazards, it’s vital to stay on top of developments.

“Sometimes our textbooks lag behind a little bit, so if it’s a skill issue . we’re often using additional resources, like the CDC or any of the online national institutes of health, to try to make sure what we’re teaching is current,” she said.

Infectious diseases are no different, and students and instructors try to keep abreast of an ever-changing health care climate.

“Wherever it’s relevant to a discussion, we start talking about it,” she said.

Students face illness through clinical participation, Guernsey said. During their first year, students take on eight-hour shifts, most often through a partnership with CCH.

“The nurses take care of patients for their entire lifespan, from birth to death,” Posten said. “We try to visit those types of clinical sites.”

By the time they’re in their second year, they’ve progressed to 12-hour shifts - on par with registered nurses.

After each clinical shift, students return to the college to discuss what they learned that day.

“Most (second-year students) are to the point now they can care for two patients, give meds and do IVs. What we do in our post-clinicals is just kind of wrap-up our day and summarize some learning experiences,” instructor Amanda Malyurek said. “One student each day gets to go over to intensive care unit and precept with an RN - more one-on-one with sicker patients that have higher acuity.”

To further that immersion, some students during their fourth semester will take part in a preceptorship, stepping away from faculty supervision to be chaperoned by a working nurse, Posten said

“They can’t miss class, they can’t miss anything like that, but they’ll go work,” she said. “It’s weekends, nights, afternoons - whatever that nurse’s schedule is.”

The experience serves as a “mini job interview,” Posten said. “The employers want to see them at the workplace, they want to kind of try them out. We tell the students to treat that entire experience like a job interview. They are being screened at that time.”

The CDC has changed personal protective equipment, or PPE, requirements in light of U.S. Ebola cases. To keep nursing program faculty up to date on those requirements, CCH provides those individuals free training.

“The hospital provides training to our faculty for free … and then they bring it back to not only the other faculty that maybe weren’t able to attend, but also carry it out through instruction with the students as well,” Posten said.

There is a strong relationship between the hospital and the college, and students are made aware of any CCH policy changes, she said.

The CDC recommends that all individuals treating Ebola patients cover their skin completely to prevent the spread of the virus. CCH is working above and beyond that standard, Taylor said.

Using helmeted powered air purifying respirators, or PAPRs, and 75 newly ordered DuPont Tyvek suits, the response team won’t run the risk of skin exposure, she said.

“Any staff that goes into an Ebola room would wear a PAPR. We have that set up,” Taylor said. “The PAPR has a shroud that goes over the shoulder. At this point in time, we have surgeons’ gowns to use. However, we have ordered some DuPont Tyvex suits that will actually protect you more. . We expect those to arrive any day now.”

In addition to the PAPRs and safety suits, team members will wear three layers of gloves and leg coverings, Taylor said.

“By the time the nurse or physician is totally gowned … they are covered from head to toe, and basically covered two or three times,” she said.

A three-person system for donning and removing safety equipment will be implemented “to avoid any unintentional or accidental exposure” to the virus, she said.

The students are still far away from combating diseases like Ebola, but they know one day they’ll be put into a position where they’ll have to think on their feet.

“It’s good to have a plan - we need to have a plan, obviously - but it’s important to take a deep breath, get your frustration out and then just refocus,” Malyurek said.

Through their experiences, the students have learned some things can’t be predicted.

“Even though you try to prep and you try to have a plan in place, it’s not always going to go according to plan,” second-year student Lucas Schipanski said.

For the first-year group, the hardest challenge is acclimating to their chosen career path. They’ll need to think outside the box to take on certain parts of the profession.

“I just think the most difficult thing is learning how to think like a nurse. All of our tests and everything, it’s really a lot of application and real-world stuff,” Folda said. “It’s not just what’s in the book - you have to use your head and you have to think about it.”

Smiley agreed, adding that nursing is different than other degrees.

“You can’t just memorize information, you actually have to know it and know how to apply it,” she said. “You’re trying to get your brain to learn to be that second nature.”

“As nurses, we are the cog of the wheel,” Malyurek said. “We need to have a 360-degree perspective of everything that is going on.”


Information from: The Gillette (Wyo.) News Record, https://www.gillettenewsrecord.com

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