Betsy Peyton is a community health nurse in Virginia who founded WellAWARE, a program that connects high-tech medicine with clients’ low-tech, high-touch needs—the grassroots, person-to-person program zeroes in on those who might fall through the cracks.
Peyton and two other community health workers regularly visit about 60 clients across central Virginia, focusing on people who frequently use local emergency rooms for low-acuity health problems while avoiding preventative primary care.
During a recent visit with her patient, Dorothy Bishop, Peyton was asked if eating grapefruit would interfere with her medications. Peyton advised avoiding grapefruit because it can hinder the stomach’s natural enzymes and cause too much or too little of her medicines to be absorbed. The discussion then went to Bishop’s foot pain and whether her landlord had resolved a mildew issue in her apartment.
WellAWARE is just shy of its third anniversary and has already shown great results, with clients using the emergency room 48% less often and being hospitalized 30% less frequently for at least six months. Peyton hopes to secure funding to continue and expand the program and sees its value to humans and hospitals’ bottom lines in real-time.
Daily Nurse proudly names Betsy Peyton the Nurse of the Week for using home visits to build relationships with patients and her appreciation of the therapeutic value of listening to people’s stories to help clients overcome entrenched barriers to good health and healthcare.
Peyton and WellAWARE’s staffers are professional problem-solvers who organize medications, offer nutrition counseling, purchase air conditioning units, and intervene with difficult landlords. They also provide rides to food banks and pharmacies, pass out gas and grocery cards, figure out what to do if the electricity or water’s been cut off, and even handle a snake in the house.
As a University of Virginia (UVA) School of Nursing student, Peyton was inspired to pay special attention to the patients who sometimes got overlooked. After becoming a nurse, Peyton worked in group homes with dementia patients in a locked psychiatry unit and found a passion for being with people when they’re “not at their best.”
“I love going on visits and reminding myself of how great and rewarding it is to sit with someone. Sometimes, people who are not at their best bring about healthy outcomes through this. It’s not hanging IV, but you’re talking about important stuff and motivating change. Sometimes you’re strengthening their relationship with the health system,” she says.
Peyton says she respects the dignity of people when they’re struggling.
“Psychiatric nursing is a field where you’re often called to be with people and hear their stories. I’ve always appreciated the therapeutic value of listening to people’s stories,” she says.
For most of 2021, Peyton knocked on doors, chatted on porches, attended neighborhood association meetings, and tuned in. Guided by census-tract maps showing areas where citizens frequently turned to emergency rooms for primary care, Peyton’s approach built trust, giving community members a sense of ownership in the project.
“We want people to trust that the system wants what’s best for them, wants to know their stories, and cares deeply about their situations. And so trust is key to trust. It all comes down to trust,” says Peyton.
What began as a collaboration with the Charlottesville Free Clinic, UVA Primary Care, and Central Virginia Health Services, WellAWARE now offers help that augments the groups’ services and the clients’ needs. Peyton and her colleagues do house calls, the kind of care she was drawn to, which has been demonstrated to save money.
“When the healthcare system saves money, it’s good for everyone. But that’s not what I wake up most excited about,” says Peyton. “The benefits to the community, neighbors, local families, and individuals make this work worthwhile. It really works.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Christina Flint-Lowe, a nurse practitioner at Bay Pines VA, works continuously to ensure Veterans and their loved ones know they are safe at the VA.
“What I value about working at VA is that we approach challenges with our Veterans’ care at the forefront. When I worked in the private sector, the model was always very results-driven, but being here flips the script a little. I get to honor the Veteran with each decision I make,” says Flint-Lowe.
Flint-Lowe’s connection to her culture didn’t deepen until she became an adult, and her heritage and work are inextricably intertwined.
Daily Nurse is proud to name Christina Flint-Lowe our Nurse of the Week for her dedicated service to our Veterans and outreach to local native communities to educate staff about Native American customs and traditions.
“I am a member of the Poarch Band of Creek Indians. I didn’t grow up on the reservation, but my grandparents were part of the community. Growing up, they didn’t talk much about being native, but I think part of that was a protective feature. They were living in a time when it wasn’t popular to identify as being Native American.”
When Flint-Lowe visited her reservation, there was a familiar feeling. The more she learned, the more knowledge she craved, and the desire for understanding deepened when she gave birth to her son.
“My want to learn is for myself and my son because I want to pass our heritage on to him. Later in my adulthood, I decided to go back to school to receive my master’s in Native American Leadership. Through those courses, I realized I have a responsibility to something greater than myself.”
In addition to her role as a nurse practitioner, Flint-Lowe also serves as Bay Pines VA’s American Indian/Alaska Native Special Emphasis program manager. In this role, she conducts outreach to local native communities and educates staff about various customs and traditions.
“I encourage people to remain curious and open because, through that process, people reach a mutual understanding and respect of one another. My story is just one of many, but I feel honored to be a representative of the community. It’s something I don’t take lightly.”
Flint-Lowe has never shied away from voicing what she feels is right but knows that being a representative in any capacity requires balance. Advocacy remains at the forefront of her mind as both a nurse practitioner and a Special Emphasis program manager.
“My work requires managing my expectations while truly considering the needs of those around me. Being provided the opportunity to have leadership in both roles at VA fills me with gratitude.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Dana Shomo, RN, BSN, is a Nurse Manager Outpatient Surgery/Post-Anesthesia Care Unit at Augusta Health in Virginia’s beautiful Shenandoah Valley.
As a leader and a mentor, Shomo is valued and is a resource for many at Augusta Health, and in March, Shomo was awarded the 2023 Augusta Health Leadership of Excellence Award. Daily Nurse is proud to name her our Nurse of the Week.
Other leaders seek her out for her enthusiasm, innovative problem-solving, and patient/community-centeredness because Shomo leads from her heart, is compassionate, and cares for others personally and professionally to foster growth and trust.
Shomo knew she wanted to be a nurse; it had always interested her. So when she was 18, she started working at Augusta Health as a clerk in the Emergency Department and became a nurse in the Emergency Department after receiving her associate degree in nursing from Virginia Western Community College. Then she returned for her Bachelor of Science in Nursing from Eastern Mennonite University. Eight years were spent in the Augusta Health Emergency Department when Shomo and her husband decided to travel around the U.S performing emergency nursing in multiple states and hospitals.
As a nurse in the ED and traveler, Shomo learned to adapt and became a fast learner. She consistently sought learning opportunities and happily returned to Augusta Heath in 2018 to be a nurse in Post-Anesthesia Care (PACU)/Outpatient Surgery (OPS). She later transitioned to a leadership role in 2021.
“When we were done traveling, we knew we wanted to return home to Augusta County,” explains Shomo. “Being from a small community within Augusta County, traveling to many hospitals across the United States, Augusta Health was where I wanted to return to work and continue serving the community I was raised in.”
At Augusta Health, she is known for her love of orienting new employees and students, which translates to her wanting them to stay at Augusta Health. She keeps nurses happy by improving unit productivity, morale, and patient experience. She enjoys celebrating birthdays, holidays, and special events. Her units have fun in the workplace, including Easter Egg hunts and cookie bake exchanges.
Shomo recently completed the Virginia Nurses Associate leadership training and was instrumental during the Pathway to Excellence journey and survey. When asked what values are essential to her as a leader, Shomo says, “being respectful, communicating, being honest, dedicated, held accountable, and compassionate.”
Shomo and her team go above and beyond to provide their patients the best experience and care. As a mentor, she says, “Each day, you will learn from others and teach others. Share your love, kindness, and the unique gifts you have with everyone you meet. Always stay true to who you are and what you believe in. If your gut is telling you it doesn’t seem right, it’s probably not. You should ALWAYS listen and ALWAYS advocate for your patient. Treat each patient as your mother, father, brother, sister, or loved one because they are someone’s loved one. You will never know your impact but know in your heart that you make a difference in someone’s life daily.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
The Black Hawk helicopter lands in a field behind the FBI Academy, its main rotor sending up a massive plume of dust and grit.
A handful of Uniformed Services University (USU) Graduate School of Nursing (GSN) Registered Nurse Anesthesia students hunker down over the litter they’re carrying to protect themselves and their “patient” from the helicopter’s powerful downwash.
Given the “all-clear” signal, the team gets up and moves to the Black Hawk, staying low under the awesome power of the blades as they evacuate their casualty. The students, using hand gestures to communicate, then work with Navy Cmdr. Ken Radford, USU’s Nurse Anesthesia program director, to intubate the training mannequin, their simulated patient. The first student is successful; Radford offers them a fist bump, and it’s time for the next student to step up and give it a try.
These GSN students are taking part in the Trauma Culmex training exercise held in conjunction with the FBI’s elite Hostage Rescue Team in Quantico, Va., just days before their graduation from USU.
Radford says GSN faculty have provided training for the Hostage Rescue Team medical personnel in the past, which helped to open the door for the nurse anesthesia students to receive their own educational opportunity on the FBI Academy grounds.
“This is the first time that we’ve held this simulated trauma experience so this is an incredible opportunity for them to round out their training,” Radford says.
The event was conceptualized by Dr. Matthew Welder, special assistant to the USU President for operational medicine and Radford, and executed by Air Force Lt. Col. Janet Sims, director for Simulation and Navy Lt. Cmdr. Lauren Suszan, director of Clinical Education, for the RNA program at USU.
The Trauma Culmex was developed to fulfill the registered nurse anesthesia student trauma simulation curriculum requirement in their last semester of clinical education. Students take part in training and exercises focused on providing care in austere environments for both injured service members and military working dogs.
Radford says providing his students with a chance to close out their training with the event helps to get them in the right mindset for an operational deployment.
“Our mission is to train anesthesia providers that can provide anesthesia care in austere settings and this was a way for us to round out their education as they approached graduation,” Radford says. “It’s really incredible.”
Inside one building, its walls still spattered with the bright paint of simulated training ammunition used to mimic live bullets during exercises, USU students work on crisis actors made up to look like they have a host of traumatic wounds. Instructors analyze the decisions of the soon-to-be-graduates as they manage the series of injuries their patients experience.
Sims checks in on one group, making sure all of the many moving parts of the trauma culmination exercise are running smoothly before heading back outside. There, a team of four load their patient onto a military ambulance, climbing on and providing care as the vehicle drives off. Sims says their mission with the exercise is to prepare independent military anesthesia providers to give care in any operational and austere environment. She adds that partnering with the FBI and the Hostage Rescue Team was a natural choice to help meet this mission.
“USU students are well-prepared to provide medical care in fixed medical facilities with adequate staff and equipment,” Sims says. “However, operational readiness courses (like this) help prepare them for anesthesia care in the field.”
As students go from one exercise scenario to another, flash bangs go off, the rattle of gunfire echoes nearby, and FBI teams train only feet away in the next room.
“(The students) are taking care of patients with minimal equipment in a building of opportunity, transporting patients and dealing with all that comes along with that — lack of supplies, lots of noise, flash-bangs going off, gunfire, helicopters taking off and landing,” Sims says. “We also have to take care of the military working dogs as CRNAs (certified registered nurse anesthetists) when we’re deployed because they are one of the team and if they get hit, we take care of them until we can transfer them to a higher level of care.”
At another location students are being introduced to a retired military working dog and a half dozen “wounded” canine mannequins. The real dog waits patiently as the new group files in to learn about working with an injured military canine in the field.
“The experience has been great,” says Army student Maj. Andre Brown, adding that he and the others didn’t initially know what to expect before arriving for the exercise. “They hadn’t really given us any information before we got here. It was ‘hey, get a hotel at Quantico, meet at this place and these are the times we’re going to start.’ Then we get out there and it’s like ‘here’s your scenario, go — how would you react?’”
Brown says one of the day’s impactful lessons was learning about how to give care to an injured military working dog.
“I knew enough to get the dogs from point A to point B but here we’re learning more effective care, and a more effective means of how to do things,” Brown says. “… Everybody has been super knowledgeable with helpful tips that I hadn’t even thought about.”
Sims says this year’s collaboration with the FBI and the Hostage Rescue Team is essentially a test run for future trauma culmination exercises. She says the university currently has the “Gunpowder” exercise which helps expose USU students to a variety of challenges they may come across in the field, training them on tactical field care, tactical combat casualty care, prolonged casualty care, and forward resuscitative care.
“Unfortunately, the timeframe (for Gunpowder) does not align with most of our nurse anesthesia students as they attend a 21-month clinical rotation at various locations throughout the country” Sims says. “We’ll see how this exercise goes and obtain feedback from the faculty cadre and students and add or remove content to make it most beneficial to train and assess their trauma anesthesia skills.”
Navy student Lt. Cmdr. Joseph Dimarucut says taking part in the Trauma Culmex has been an amazing experience. Particularly, he says working to intubate a patient from within the confined space of a helicopter stands out to him as a valuable lesson that couldn’t be practiced in a hospital.
“It’s a good culmination of everything that we’ve learned put into practice and what we’ll expect to see in the field,” Dimarucut added.
Hurrying past FBI agents rappelling down a wall, the next group of USU graduate nursing students carries a litter holding a simulated patient, an instructor following closely behind. They arrive at an open field and soon the sounds of a helicopter’s rotor chopping through the day’s warm air once again grows louder. The dust hits them, they get up and hurry for its open doors and the training begins all over again.
How often – and how well – do nursing programs teach lessons about the impact that climate exerts on health? And as more of us are exposed to and sickened by toxins, polluted air, unsafe drinking water, and a lack of access to basic health care – not to mention the economic, geographic and social effects of rising tides, stronger storms and predictably unpredictable weather – should climate lessons be mandatory for clinicians?
“In public and environmental health,” University of VirginiaMSN student Amelia Kirby, BSN, RN explained, “that Venn diagram, that overlay, is really close.”
Kirby began her professional life working in nonprofits before heading to nursing school in spring 2020, just as COVID struck. Two years later, Kirby – who on May 22 earns a master’s in nursing through the UVA’s Clinical Nurse Leader program – says it couldn’t have happened any other way. And the environmental causes she embraced since childhood continue to flavor her nursing and determination to do good for both the planet and its human residents.
“I thought entering health care would be the end [of my environmentalism], but it’s turned out to be quite the opposite,” Kirby said. “There are a lot of people in nursing and medicine who care really deeply about the planet, and they’re motivated to change things. It’s very buoying to see how many people are interested in this.”
A climate and health conference in early 2021 first brought Kirby into contact with UVA nursing professors Tracy Kelly, Emma Mitchell and Kathryn Reid, champions of the Nurses’ Climate Challenge, which offers tools, resources and support for faculty committed to teaching climate and health lessons in their courses.
As Kirby’s environmentally minded connections multiplied, so did her ideas and determination to act. Over the last year, she led in developing a Planetary Health Report Card tool for measuring nursing schools’ planetary awareness. The work has presented speaking opportunities at conferences, and landed a national award and other applause from national nursing and environmental groups.
The first Planetary Health Report Card tool was created in 2019 by a group of University of California, San Francisco medical students to assess across five metrics about the climate consciousness of medical programs.
Following a similar model, Kirby, fellow clinical nurse leader student Alyssa Dimatulac, and a team of nursing students from the University of Minnesota, the University of Brighton, the University of Lancaster, and Germany’s Esslinger Science and Health College compiled their own tool to assess nursing programs’ environmental mindedness across curricula (how well and how often nursing courses embed topics of climate’s impact on health), day-to-day sustainability practices, student support, community impacts and interdisciplinary research. She hopes the tool ultimately becomes a commonplace way for prospective students to assess programs that align with their personal values.
Supplies of N95 face masks, surgical face masks, and face shields at US hospitals are under the microscope in the latest research project led by nurse scientist Kelly Aldrich, DNP, MS, RN-BC, FHIMSS, associate professor of nursing informatics at Vanderbilt University Nursing School.
The DNP and her team are receiving CDC funding to the tune of $80,000 to support their analysis of daily hospital personal protective equipment (PPE) on-hand inventories to measure trends, patterns, or statistically significant changes in PPE supply in the nation’s nearly 7,000 U.S. hospitals. The project is designed to support the CDC’s National Personal Protective Technology Laboratory, which was established under the aegis of the National Institute for Occupational Safety and Health (NIOSH) in 2001 and invested with the mission of preventing disease, injury, and death for the millions of American workers who rely on personal protective technology (PPT).
“In analyzing the data with advanced analytics, we will be able to find patterns that were not seen before. I think because of that, it will have a true impact on supply chain management for the country.”
Aldrich is being supported by a Vanderbilt team that includes four second-year data science students under the supervision of Jesse Spencer-Smith, chief data scientist of the Data Science Institute, and Dana Zhang, professor of computer science and electrical engineering, to leverage artificial intelligence and data modeling for this large-scale analysis and reporting effort.
Nurse scientist Kelly Aldrich, DNP, MS, RN-BC, FHIMSS.
“We’re conducting data analysis on a medical organization’s average consumption rates to figure out if they have enough PPE and other essential items to provide for their teams,” Aldrich said. “In analyzing the data with advanced analytics, we will be able to find patterns that were not seen before. I think because of that, it will have a true impact on supply chain management for the country.”
“By [enlisting the aid of] the Data Science Institute to support this important work, Dr. Aldrich has deepened and extended the research while providing a meaningful opportunity for our team to put their expertise to use,” said Jesse Spencer-Smith, chief data scientist for the Data Science Institute. “Our faculty and graduate students formed a team that is enabling this analysis to go from simple data points to insights that can shape the country’s future responses to health care events.”
Study aims to increase transparency and efficiency of PPE supply distribution
The necessity of this effort was brought to light by pandemic-related lack of access to PPE due to supply shortages or prohibitive costs. In the early stages of the pandemic, the World Health Organization called on industry and governments to boost PPE manufacturing with a warning of “severe and mounting disruption to the global supply of personal protective equipment—caused by rising demand, panic buying, hoarding and misuse.”
The WHO was right. Months into the pandemic, PPE shortages among hospitals, nursing homes and medical practices across the U.S. put health care providers and patients at heightened risk of exposure to COVID-19. Two goals of Aldrich’s project are to bring transparency to PPE supply across the country and to eliminate the common problem of one hospital having a PPE surplus while neighboring hospitals scramble.
The project is a follow-up to a 2020 project Aldrich led with the Center for Medical Interoperability, a national nonprofit working to integrate health care technologies for information exchange, and the National Personal Protective Technology Laboratory, part of the National Institute for Occupational Safety and Health. The TOGETHER for PPE project phase connected 78 hospitals in nine federal Health and Human Services’ regions. Thousands of real-time data points allowed for predictive modeling and other data analysis which helped hospitals and the CDC examine exactly what PPE they had on hand, which enabled hospitals to plan and develop solutions that kept caregivers and hospital patients safe. A paper on the project phase entitled Lessons Learned from the Development and Demonstration of a PPE Inventory Monitoring System for US Hospitals was published in the journal Health Security on Nov. 9.
Aldrich’s trans-institutional project will restart and amplify the TOGETHER for PPE effort. The data collected by Aldrich’s team in 2021 will focus on N95 face masks, surgical face masks, and face shields.
“Collaboration with the Data Science Institute in data modeling and data analysis with predictive and artificial intelligence models are of high priority,” said Aldrich, also the director of Vanderbilt’s new Nursing Informatics Innovation Lab within the Vanderbilt School of Nursing and the chief clinical transformation officer for the Center for Medical Interoperability. “This collaboration is a terrific example of bringing researchers together with diverse areas of expertise and distinct backgrounds to discover new information. We are excited about the progress to date.”
