Monthly Archives: August 2017

Nursing Graduate Student Exemplifying Love through Refugee Care

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Nicki Broby completed refugee research in Jordan and Greece.

As August graduation draws near, graduate student Nicki Broby looks back at how far she has come since starting the family nurse practitioner program (BYU’s master degree in nursing), as well as see how life prepared her for her research focus.

Broby’s nursing career began while she was on an LDS mission in Washington D.C. She was serving during the 9/11 attacks, and one of her immediate responsibilities was to help the Red Cross in their relief efforts. As she finished this service, she realized that nursing was the right path for her.

She transferred from BYU to Arizona State University to study undergraduate nursing, and after graduation started work in a pediatric intensive care unit with no thought of becoming a nurse practitioner. That changed when she got the service opportunity of a lifetime.

“In 2011, I quit my job in the PICU because I had the chance to live on a Navy ship for five months,” she says.  As an LDS Charities nurse representative, she traveled with other volunteers to nine countries, providing medical services to around 80,000 people. While serving as a translator for various nurse practitioners, she developed a deep respect for their ability to offer high levels of care to patients, sparking a desire to earn her advanced nursing degree.

Read Related Story: Five Month Nursing “Cruise” On A Naval Hospital Ship

After serving a two-and-a-half year part-time mission for the Church as a medical volunteer, she entered BYU’s graduate program in April 2015 and focused a thesis project on what makes international aid interventions effective.

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“When I was doing my thesis, I found out that there was very little information for someone who says, ‘Hey, I want to start my own international medical disaster response team,’” she explains.

She presented the idea to then associate dean Dr. Mary Williams, who was immediately supportive and helped her assemble her committee, which included Dr. Jane Lassetter and Dr. Blaine Winters. All proved invaluable as mentors during the entire project, helping Broby improve as a nurse, writer, and researcher.

Step one was to interview leadership in various aid organizations in the United States, getting their opinion on what made their operations effective. Those interviews were transcribed and evaluated for successful strategies. Step two required obtaining input from workers on the ground.

“To do that, I was hosted generously by the International Medical Corps at their field operation sites in Greece and Jordan,” Broby says. For two weeks, Broby and a colleague traveled to three refugee camps, interviewing dozens of local aid leaders to figure out what improved and impeded their successes.

“It was jam packed; it was amazing and exhausting, and extremely informative,” she says. Their research highlighted various factors that people who want to get involved in aid work should consider. It also gave her a closer look at the refugee crisis, offering her precious insights into how ordinary people can show charity through service.

 

DSC_0765Broby also admires how both BYU and the College of Nursing specifically rely on the teachings of the Savior to enhance students’ experiences.

“It is obvious that Jesus Christ is the exemplar that we’re not just told to follow in this program, but that our professors are following,” she says. “That touches everything that we do, whether we are learning about how to treat the common cold or going to a refugee camp in Greece, it touches all of that, it changes all of that, and it deepens all of that.”

Immunization Exemptions and Pediatric Care

As a family nurse practitioner working in a pediatric outpatient clinic, assistant teaching professor Lacey Eden (BS ’02, MS ’09) educates parents about the general health of their child. Eden frequently addresses parents’ questions and concerns regarding immunizations for their child due to the requirement that parents provide either proof of completion or a certificate of exemption before their child can be enrolled in school.

Because of her experiences talking with parents about immunizations, Eden decided to research the rising immunization exemption rates in Utah. She is currently working on a standardized education module for immunization exemptions and also a mobile app called Best for Baby.

Education Model for Immunization Exemption Rates

Immunization exemption rates, particularly those granted for philosophical reasons, have risen drastically in Utah over the last few years. The rise in exemptions may have played a role in several recent outbreaks of vaccine-preventable diseases (measles and pertussis) in Utah, which prompted Eden to research the education provided for parents who wish to obtain an exemption. Currently she is investigating the specific education requirements for philosophical immunization exemptions in all states across the country and how effective this education is at combating the rise in exemption rates.

In her research, Eden found that all 50 states allow medical exemptions for immunizations, 48 states allow religious exemptions, and 18 states allow philosophical exemptions. Utah is one of the 18 states that allows all three types of exemptions. While 18 states allow philosophical exemptions, only 14 states require education before granting exemptions. The type of education parents receive varies from state to state and from county to county throughout Utah.

Eden has discussed her study with several prominent leaders of various associations and departments, including the health director and the immunization manager at the Utah State Health Department and the chair of the Utah Department of Human Services, in efforts to implement a standardized education module for Utahns to complete in order to gain a philosophical immunization exemption. She has also been invited to participate on an immunization exemption task force with several key participants in the state and with fellow College of Nursing faculty—Dr. Beth Luthy (MS ’05), Gaye Ray (AS ’81), Dr. Janelle Macintosh, and Dr. Renea Beckstrand (AS ’81, BS ’83, MS ’87). This task force is charged with creating a standardized education module that can teach parents the signs and symptoms of diseases, what to do if their child contracts a disease, and what to do in the case of an outbreak. The module will also answer frequently asked questions about immunizations and provide information about obtaining low-cost immunizations.

The Association of Immunization Managers and the Centers for Disease Control and Prevention have contributed to this project by aiding in the data-collection process and reviewing the research questions on educational requirements in reducing immunization exemptions.

Best for Baby App

In 2013, the Advisory Committee on Immunization Practices (ACIP) published its recommendation that pregnant women should get a Tdap vaccination between 27 and 36 weeks of pregnancy. Infants do not receive this vaccine until two months of age, but in the womb they do inherit temporary protective antibodies from their mothers, so it is essential for mothers to receive the vaccine and pass antibodies to their children in utero.

Despite being recommended by the ACIP, very few women receive the Tdap vaccine during their third trimester, so Eden, who serves as chair of the Utah County Immunization Coalition, decided to educate soon-to-be parents through a free mobile-device app called Best for Baby (now available on iTunes).

Though geared toward increasing Tdap immunization rates, the app does much more than just teach about vaccines. The program sends expectant parents weekly push notifications that provide updates on their baby’s development and when they need to see their OB/GYN. Additionally, updates tell parents what tests to expect at their next appointment, what those tests look for, and why they are performed. The app continues to give parents monthly push notifications for two years after the birth of the child. These updates include when the child should see a care provider, what developmental milestones he or she should reach during the month, and what immunizations that child should receive.

I Would Learn The Healer’s Art

As a part of the 50th anniversary of the BYU College of Nursing, a book was compiled called “The Healer’s Art: 50 stories for 50 years.” It has been 15 years since this book was first published and these stories were shared. We plan to regularly post selections from this book to help each of us remember and cherish the experiences of nursing and learning the Healer’s art. 

I Would Learn The Healer’s Art

Judy Malzahn Ellsworth

Working in the Operating Room at Fairfax Hospital in Northern Virginia meant never having a dull moment.  Fairfax Hospital is just blocks off the western end of the Washington D.C. Beltway on the Virginia side.  Each day brought new challenges, and we had to be ready for anything.

I was working as the Assistant Head Nurse in charge of the Operating Room from 4:00 pm until midnight every day.  One Sunday afternoon I got a call from the delivery room telling me that they had a very serious situation.  A mother who had just delivered was hemorrhaging and they were unable to control it…did we have an operating room available?  We had four rooms running, and that was the maximum we could run that afternoon.  I told them I would call them right back.

I talked with Anesthesia, and we decided that I could scrub the case, and we would pull a circulator from a case that would be finishing within the hour to circulate for me, if Delivery would send an RN down to circulate in the ‘easy’ room.  Arrangements were made with the Critical Care Supervisor to man the OR desk, and the go-ahead was given for the case to proceed.

I rushed to pull the case, scrub, and set up the room.  While I was busy, the doctors brought the anesthetized patient into the room and prepped her for abdominal surgery. I put all the drapes on a draping table and told them they were on their own, as I was still opening instruments and setting up the Mayo. By the time I brought my Mayo to the field, I had gowned and gloved a doctor and two residents, and the patient was fully draped and ready to go.

The case was truly a serious situation.  This was in the days before the ‘Bovie’, and we clamped and tied each bleeder.  Every time a bleeder was clamped, the clamp acted like a hot knife going through butter.  We changed to using a needle to just tie off the bleeders.  This didn’t work any better.  We packed her abdomen and waited to see if the bleeders would clot off.  This was not successful.  The situation was getting desperate.

I was feeling heartsick at our seemingly helpless situation.  I knew this particular doctor was not one that any of us would refer anyone to, and I knew we needed help.  I felt like the patient was my sister, and I could feel the tears beginning to sting my eyes.  I was the charge nurse, and I was scrubbed in the case and unable to call for anyone to come to help us.  While we were waiting to see if packing the abdomen was going to be successful, I turned to my back table, closed my eyes and pleaded with Heavenly Father to please send someone quickly, as this new mother needed more help than this physician was able to give her.

About 10 minutes later the door to the operating room opened slightly and the Chief of OB/Gyn peeked inside.  He said he’d been out on a Sunday drive with his boys, and he felt like he needed to stop in at the hospital to see how everything was going.  The doctor who was operating explained the situation, but said he thought he had everything under control.  The Chief asked if he thought he could use another hand, to which the doctor said, “No!”  I was shocked, and I looked at the Chief and said, “I have an extra gown here, what size gloves do you wear?”  (He later told me the look in my eyes told him he’d better start scrubbing STAT!)

We worked for three more hours, with the Chief eventually taking over the case.  The patient was saved, and my grateful heart said several prayers of thanksgiving while we were working.

As we were finishing the case, the doctor said that he was so happy that we had been able to save her.  She was LDS and this was her eighth child.  I said to him, “Will you tell her that I am also a Mormon, and I was her nurse during her surgery?”

When the patient was taken to the Post Anesthesia Care Unit (Recovery Room), I realized that the doctors and circulator had forgotten to take her chart with them.  I picked the chart up and started to take it to PACU when I read the nameplate of the patient.  Imagine my shock when I realized that my impressions during the surgery of this being “my sister” were correct.  She had been my visiting teaching companion when we both lived in Seattle, Washington several years before!  Neither one of us knew that we were now both living in the Washington, D.C. area.

I called up to the Delivery Room and asked for her husband to come down to the Recovery Room.  When he arrived, I asked him if he had his consecrated oil with him.  He did, and he had a friend with him.  I arranged for them to give his wife a blessing.

I am grateful that not only was I privileged to learn The Healer’s Art at the Lord’s university, but that I was also taught to listen to the promptings of the Spirit and act accordingly.  Being a BYU graduate has been an honor, and it has allowed me many missionary opportunities.  Being a member of The Church of Jesus Christ of Latter-day Saints has been an enormous blessing to me personally, and to all those who have been entrusted to my care.

Trekking for Cultural Understanding

Amy Boswell looked down at her hiking shoes and sighed. The deep tread on the bottom had long since filled with mud and was now useless. She had known there would be a lot of trekking on the trip, but this went beyond that. Going straight up the mountain, no switchback trails, she wondered how the native guides ahead of her did this day in and day out. Suddenly her foot slipped. Startled, sliding, skidding, she fell. Finally stopping, covered with mud, she looked up to see a smiling guide, hand stretched out to help her back up.

In spring 2016 BYU College of Nursing students traveled to Vietnam for the first time. There they experienced a clinical practicum for the Public and Global Health Nursing course unlike any other. Students journeyed to a remote region in northern Vietnam, visited the hill tribes there, lived with local families, and provided instruction on healthcare. This cultural immersion provided an exceptional experience for students to gain perspective they will apply in their future careers.

 

THE PREPARATION

Associate teaching professor Cheryl A. Corbett (BS ’89, MS ’96) knew she needed to find a site where students could learn from a truly foreign culture. She knew Vietnam would fit the bill, but she did not know how enthusiastic students would be.

“One of my concerns was if I would have students who would want this kind of experience,” Corbett says. “We needed students who could sleep with the bugs, live in the rafters with the people, and eat their unique foods—things which might put someone out of their comfort zone.”

Corbett pressed forward with her plan and traveled to Vietnam for a two-week scouting trip. She found great clinical opportunities among some amazing people and came back ready to take students who were willing and ready to go on an adventure.

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THE TREKKING

Nestled near the Chinese border in the hills of northern Vietnam is a town called Sa Pa. Residents include people from several ethnic minorities, including the Hmong, who also live in scattered tribes across the surrounding countryside. Nursing students spent three weeks trekking up and down mountains to reach these villages. With the help of their three Hmong guides, the nursing students were able to reach several isolated communities, sometimes hiking 10 to 12 miles per day.

“Our guides were literally in slip-on sandals running up and down the mountains,” says Boswell, a sixth-semester nursing student. “Here we were in these beautiful hiking shoes slipping and falling everywhere we went. I remember one guide, named Mai (we called her Mama). She would always help us up after a fall. I especially had a reputation for falling up and down the mountains.”

With the nearest healthcare facility more than eight hours away, students had to rely on their own abilities and use caution. However, even though the trekking was more intense than expected, the group realized it was worth it as they became immersed in the unique culture.

“The people in the hill tribes are shy, but they want to share,” says associate teaching professor Karen M. Lundberg (AS ’79). “Our Hmong guides were able to get us into tiny villages that we wouldn’t have been able to get into otherwise.”

The group found that simply spending time with the people worked best to help them open up. Rather than quickly asking to see homes and healing practices, they stopped and took the time to communicate with them through gestures, smiles, and exchanges. And with the help of their guides, the students felt the Hmong people become receptive.

 

HMONG HEALING PRACTICES

None of the group members will ever forget the elderly female shaman they came across performing a ceremony in one of the villages. The Hmong people believe they have a certain number of spirits in their body. When they get sick the spirits leave, and it becomes necessary for a shaman to perform rituals to collect the spirits and put them back in the bodies of patients. The memorable healing ceremony included the shaman sacrificing a duck.

Following the experience, group members were struck by the reaction from the people of the village. Lundberg recalls the trust that developed because they were accepting of the Hmong culture. “After we had that experience, the shaman asked us to see one of her grandchildren, who suffered from something like cerebral palsy,” Lundberg says. “She wanted to know if the child could be cured if he went to the hospital; the family wanted our opinion. I believe if we had just walked in and asked if there were something we could teach or do, they wouldn’t have let us in to see this child.”

Although a hospital trip wouldn’t have cured the child, students were able to provide him with care to make him more comfortable. They found this developmentally delayed child lying in a state of atrophy. His feet had been tangled in a fishing net so tight that it cut off his circulation. The students checked his skin for breakdown, cut the nets off his toes, and explained what needed to be done to further care for him. The students smiled at the child and called him by name, hoping to provide the comfort he needed.

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TEACHING AND LEARNING

Throughout their experience students learned how to build trust and listen to the people, incorporating Hmong beliefs with Western medicine to create healing together. They were also able to teach some simple healthcare practices and deliver much-needed supplies.

Eyesight is crucial in Hmong culture. Villagers make all of their own clothing, from growing the hemp plants to dyeing the finished product. The women are expected to do intricate hand stitching on all their clothing, but as they get older, they cannot see up close and can no longer be productive.

Corbett remembers distributing reading glasses they brought to these Hmong women. “To watch them put on these glasses and see a whole new world open up was so amazing,” she says. “They could see little things again. Seeing their smiling faces made me think of how much we take eyesight for granted… Getting these eyeglasses was like the best present they ever had.”

Students also got to teach dental hygiene and hand-washing techniques to the Hmong people they met along the way. The students were happy to give away toothbrushes and eager to teach good practices. They found that many families had only one toothbrush to share and would often use it for cleaning purposes, including scrubbing the mud from their shoes when they got home from the rice fields

LIVING AMONG THE HMONG

The BYU group spent nights in the homes of the people they were visiting. They slept on mats in rafters where the families usually store their rice. During long treks and the quiet nights in the villages, students had time to reflect on the people they were around.

Boswell found the generosity of the Hmong people particularly impressive. “While trekking, those we met would invite us into their home, asking if we had eaten that day and if they could share their rice,” she says. “The Hmong people have so much less to give than I do, and they were so willing at any second to just give it. I came back realizing I need to open my heart and be more hospitable and kind to people.”

The group was also impressed by the Hmong family dynamic as the villagers sat together on the dirt floors of their homes and cooked over open fires. The Throughout their experience students and families would have dinner together, talk together, and laugh together.

“Dinnertime is notable for the Hmong,” Lundberg says. “Even though they just have one small light bulb hanging over the table, they sit around and talk and laugh late into the night. It was so awesome seeing how connected the families were, with several generations living in the same home.”

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GIVING BACK

The Hmong people are subsistence farmers. During the planting season, whatever rice they plant is what they will live off of for the next year.

In one village, the students found a widow who was unable to get her rice planted. Instead of just observing her predicament, the students got to work in the rice paddy.

Corbett remembers how much the group learned from this experience. “Rather than put on someone else’s shoes to learn about them, we had to take ours off,” she says. “We were in the mud up to our knees for over five hours doing backbreaking work. It was so eye-opening to learn the intricate process of planting. . . . I think we all left with a new appreciation for rice. None of us ever want to let a single grain of rice fall off a table ever again.”

 

BRINGING IT BACK HOME

Even though their Public and Global Health Nursing course was not in a hospital setting, students found that the things they learned had extraordinary applications in their own healthcare practice.

“When students step out of their ethnocentric viewpoint, they gain the ability to see the world in a different way,” Corbett says. “They can take that and use it whenever they treat a patient from another culture. They can understand the patient’s belief and use that to help heal them.”

And students learned that cultural beliefs can vary from patient to patient. They found that some Hmong people were culturally opposed to a hospital visit while others would choose the option when they need it.

“You can’t just assume something about an individual based on the culture,” says Megan Zitting (BS ’09, MS ’16), a graduate student who came on the trip as an assistant. “What an individual believes about healthcare and what they desire the moment they’re sick and need treatment might be completely different.”

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LOOKING FORWARD

The inaugural Vietnam trip provided an excellent foundation for coming trips. This year organizers plan on helping the Hmong trek guides learn first-aid and dental-hygiene education and practices.

Students will continue to bring a minimal amount of first-aid and dental hygiene items. They do not want to change the Hmong people, just provide them with healthcare concepts. “We want them to be self-sufficient and not rely on outsiders bringing things to them. Our plan is to bring materials they wouldn’t have access to but need,” Corbett says.

Zitting adds, “You have to dig deep and establish connections in a place before you can help them. You have to be able to see what their needs are and see what you actually can or cannot do to help them. Some people have this idea that they can just help people everywhere, but it takes some time and relationship building to be able to get in there and make a difference. And we’ve got a great start in Vietnam.”

This story was published in our spring 2017 college magazine. It was written by Nathan Brown, a college student employee.