May 11, 2012
When parishioners at Southport United Methodist Church in Indianapolis come to worship on Sundays, they can get lessons in health care as well as the spiritual.
Felicia Stewart, a family nurse practitioner and church member, established a health care ministry at the church and recently developed a toolkit for use by people recently diagnosed with a chronic illness and family members who help care for them.
When Stewart needed to come up with programming or research-based health care interventions as part of Indiana State University's new Doctor of Nursing Practice program, it didn't take her long to come up with an idea.
The Sullivan native's parents, Tom and Sharon Stewart, were diagnosed with cancer just two weeks apart in January 2008. As a health care provider, Felicia Stewart bore the brunt of helping her mother and father understand their diagnoses, ensure that each took a lengthy list of medications at the right time, and juggle their chemotherapy treatments and doctors' visits.
"It was overwhelming. It was very obvious that we needed a way to be able to organize their health information, appointments, test results and medication lists," she said. "We discovered that if we just kept two separate bags - one bag for mom, one bag for dad - that was a big help."
Recording the audio of doctor visits helped reduce what could have been a two-hour phone conversation with her siblings about how each visit went to a fraction of the time that might otherwise have been required. Separate calendars also helped manage health care appointments with little or no confusion.
Tom Stewart fought his cancer for 11 months before his death and Sharon Stewart battled for more than two years. Felicia Stewart hopes the lessons she and her parents learned can help others beat their illnesses - or at least make it easier to cope.
"I had just finished my nurse practitioner program the month before they were diagnosed. I think in some ways that equipped me to be able to look at their situation and be more of a health advocate for them and be a daughter at the same time," Felicia Stewart said.
In both cases, her parents' cancers were in advanced stages by the time they were diagnosed, prompting her to consider this advice as the most important lesson in her health care ministry:
"I have a passion for early detection because it gives patients the best tools to be cured or live a longer life," she said.
Stewart's "New Diagnosis Toolkit" includes items available at office supply and big box stores - an audio recorder, a calendar, a pen and notebook, a folder to keep track of paperwork and a bag in which to carry it all.
"It's a very simple concept," she said, "Sometimes when people are first diagnosed, it takes a while to be able to look objectively and see what their needs are and pull in those resources. It may be several months afterwards when they finally think to start taking notes. That initial shock just freezes people."
The toolkit puts patients in a position to keep better track of information from day one, Stewart said.
"Being able to do that empowers them to be more active in their health care visits," she said. Angela Young, a Southport United Methodist Church member who has multiple sclerosis, credits Stewart's health care ministry with helping her better manage her visits to both a general practitioner and a neurologist.
"It's just good to know that you can be more prepared, especially when I go to see my doctor, so we can talk about things," Young said. "Felicia really opened up my eyes in the sense that I really need to write things down. Don't just assume that your doctor has all the information. Most likely they do, but you need to be your own advocate."
Helping caregivers cope
Jessica Durbin of Terre Haute focused her attention on parents as caregivers for children with physical or developmental disabilities.
She developed an online tool for parents to assess their stress level and learn steps to take to reduce stress. Of 35 parent volunteers who used the tool between January and March of this year, an overwhelming majority pronounced it a success.
"Ninety-five percent felt like it was a significant factor to decreasing their overall strain. That was exciting, first just deciding to try something, then seeing that it really does work," Durbin said.
"We as health care providers can take from this that many of the parents in our practices caring for disabled children may be experiencing significant levels of role-strain and we may be forgetting them," she said. "We can start more routine screening in our practices, we can develop sites such as the one used in this study and refer our patients to it and above all we can let our families experiencing role strain know they are not alone."
Durbin's project was influenced by her own family's experiences.
"Having seen my grandparents raise a child that was disabled along with 10 other siblings and seeing how that affected everyone else in the situation, it just propelled me to think of what we can do as providers for these patients," she said.
Young adults and chest pain
Kathy Miley's project came about as a result of her work in the emergency room at Major Hospital in Shelbyville.
"We've seen a huge increase in the number of young adults, defined as those between 18 and 40, coming to the ER with chest pains," Miley said. Concerned about that increase, she set out to learn what might be behind it.
"What we have found through the studies is that in this population, if they are in the low-risk category - meaning they don't meet any of the high-risk factors such as drug use or family history of cardiac disease - the literature supports ... treating their anxiety," she said. "The majority of them have high anxiety and stress and that's what's causing the chest pains."
Carrying her research further, Miley interviewed many young patients with chest pains and found that virtually all of them consumed energy drinks or soft drinks with high caffeine content.
"The stimulants that our young adults are using contribute to their anxiety," she said.
Publication of Miley's research is pending in the Journal of Emergency Nursing.
Miley, Durbin and Felicia Stewart completed their Doctor of Nursing Practice degrees as part of the inaugural class to do so in Indiana State's College of Nursing, Health, and Human Services.
While each was already on the front lines of efforts to help Americans become healthier, they realize much work remains as more people rely on nurse practitioners for primary health care.
Doctor of Nursing Practice is the highest degree possible for nurse practitioners. Indiana State's program is just one of several new initiatives the College of Nursing, Health, and Human Services has launched in an effort to help address the growing shortage of health care providers - especially in rural areas of Indiana and the nation.
Web-based program geared to working professionals
The online program is designed to serve working health care providers.
"When you work 40 hours a week, it's very difficult to find time for going and sitting in a classroom and making that time work because you can't," said Durbin. "The online program and the way Indiana State has integrated it with phone conferences was very impressive."
The program also enabled Durbin, Miley and Stewart to take adjunct teaching positions in ISU's nursing faculty.While she is not ready to stand in front of a class - virtual or otherwise - just yet, Durbin is pleased to have had the opportunity to help share her knowledge with future nurses.
"Teaching definitely added fuel to the fire," she said.
Two nurse practitioners from outside the state were also part of ISU's first Doctor of Nursing Practice class. Patti Thum implemented a medical home care model for a rural Pennsylvania community while Vicki Umphrey provided education and awareness on diabetes and early detection in a predominantly Native American county in Oklahoma. Native Americans have one of the fastest growing incidents of diabetes.
"To say we are proud is an understatement. Our graduates have been able to improve the lives of patients and families in their communities," said Susan Bronte-Eley, chair of the advanced practice nursing department at Indiana State. "We look forward to the future and continued growth of the program."
Photo: http://isuphoto.smugmug.com/Other/Media-Services/Diagnosas-Toolkit/i-WwhksfQ/0/L/DSC1116-L.jpg - Felicia Stewart, a 2012 Doctor of Nursing Practice graduate at Indiana State University, conducted presentations about her "New Diagnosis Toolkit" during a health fair at Southport United Methodist Church in Indianapolis. (ISU/Sam Barnes)
Photo: http://isuphoto.smugmug.com/Other/Media-Services/Diagnosas-Toolkit/i-r4B6sCC/0/L/DSC1088-L.jpg - A "New Diagnosis Toolkit" developed by Felicia Stewart, a graduate of Indiana State University's first class of Doctor of Nursing Practice students, is a collection of common items designed to help patients better manager their health care in the face of a chronic illness. (ISU/Sam Barnes)
Photo: http://isuphoto.smugmug.com/Other/Media-Services/Nursing-Photos/i-2ZJCJgC/0/L/May0520122012springcommencemen-L.jpg - Jessica Durbin (ISU/Rachel Keyes)
Photo: http://isuphoto.smugmug.com/Other/Media-Services/Nursing-Photos/i-NJW96Lc/0/L/May0520122012springcommencemen-L.jpg - Kathy Miley (ISU/Rachel Keyes)
Photo: http://isuphoto.smugmug.com/Other/Media-Services/Nursing-Photos/i-5kjdvT5/0/L/May0520122012springcommencemen-L.jpg - The first five graduates of Indiana State University's Doctor of Nursing Practice program pose for a photo on commencement day, May 5, 2012. From left to right: Jessica Durbin, Vicki Umphrey, Patti Thum, Kathy Miley and Felicia Stewart. (ISU/Rachel Keyes)
Contact: Susan Bronte-Eley, professor and chair, department of advanced practice nursing, College of Nursing, Health, and Human Services, Indiana State University, 812-237-7918 or firstname.lastname@example.org
Writer: Dave Taylor, media relations director, Office of Communications and Marketing, Indiana State University, 812-237-3743 or email@example.com
A toolkit for persons newly diagnosed with chronic illness, online help for parents who care for disabled children and a look at what triggers heart pain in young adults were among projects developed by ISU Doctor of Nursing Practice students.