Delivery of Care

Clinical nurse training program launches at HopeHealth

In the midst of the COVID pandemic, nursing students from Salve Regina engage in a clinical, end-of-life training

Photo courtesy of HopeHealth

HopeHealth Hospice Clinical Educator Cynthia Brown, RN, CHPH, discusses hospice care with Salve Regina University senior nursing students Taylor Eaton (center) and Allison DeLuca (right).

By Janine Weisman
Posted 2/15/21
A new, mentored, in-person clinical nursing program for 21 nursing students at Salve Regina University is now operating at HopeHealth Hulitar Hospice Center this semester.
What is the current demand for clinical nurses in Rhode Island, given the way that the pandemic has exacted a burden on health care delivery facilities in the state? What are the lessons learned around the difficulties of saying goodbye to loved ones during the pandemic? How are nurses and doctors coping with the stress of having patients die as a result of COVID-19, in which they are often the last ones to say goodbye? Is there a waiting list for patients to gain admittance to the HopeHealth Hulitar Hospice Center?
The most valuable possession we have, as humans, is our own personal stories. With the massive death toll as a result of the coronavirus, many of the rituals around deaths of loved ones, have been disrupted. At one point, there were a number of initiatives underway in Rhode Island at the health system level to foster conversations between patients and doctors around having the difficult decisions around end-of-life care, to make sure that the patient’s wishes were known, respected, and documented. The question is: how have those efforts been changed by the coronavirus pandemic?

Editor’s Note: In these dark days of winter, with the coronavirus pandemic still everpresent, with more winter weather forecast for the upcoming week, with the aftermath of the failure of the U.S. Senate to convict former President Trump for inciting an insurrection despite the overwhelming evidence presented by the U.S. House impeachment managers, finding the silver lining in news stories can be a difficult task.

The good news often seems to get crowded off the pages, whether it be online, in printed publications, or on Twitter.

For instance, Clinica Esperanza recently received a $315,000 grant from TD Bank’s annual Ready Challenge, focused on finding solutions for already vulnerable communities suffering the most from the pandemic’s effects, to help remove barriers and ensure that everyone has a fair opportunity to be as healthy as possible.

The investment will allow the free health care clinic, which serves the unmet health care needs of many newly unemployed and uninsured patients, to expand its services in a low-income, predominantly Spanish-speaking neighborhood of Providence, to focus on providing a continuum of primary care in order to prevent unnecessary visits the hospital emergency rooms – and improve health outcomes.

The co-founder and volunteer medical director is Dr. Annie De Groot, the co-founder, CSO and CEO of EpiVax, one of Rhode Island’s pioneering biotech firms. Tune in to next week’s edition of ConvergenceRI for an in-depth interview with De Groot and her team.

Similarly, in a nearby neighborhood in Olneyville, the finishing touches are being applied to the new Sheridan Small Home project, with buyers expected to move in this spring, in an initiative developed by ONE Neighborhood Builders. The wire mesh free WiFi system built out by ONE Neighborhood Builders is now being considered a model program for potential scaling up as a new initiative for increased connectivity, with grants provided by Rhode Island Housing.

What follows is a good news story about how nursing students from Salve Regina University are enrolled in an end-of-life clinical care course at HopeHealth’s Hulitar Hospice Center in Providence, during a time when end-of-life decisions during the time of the COVID-19 pandemic become more and more prevalent within the state’s health care delivery system – in hospitals, in nursing homes, and in hospice settings.

PROVIDENCE – Three days a week, they come two at a time to the HopeHealth Hulitar Hospice Center to meet staff, practice using equipment and participate in role-playing exercises. And, they arrive wearing their own N95 masks.

Twenty-one Salve Regina nursing students, who are enrolled in an end-of-life care course for the spring 2021 semester, are receiving a warm -- and safe -- welcome for experiential learning, thanks to a creative approach to scheduling and a commitment to “preceptorships,” even during a pandemic.

[The HopeHealth Hulitar Hospice Center, located on North Main Street in Providence, is the only free-standing inpatient hospice center in Rhode Island. People that need a higher level of hospice care to manage symptoms at the end-of-life receive around-the-clock, individualized care and emotional support.]

All the students have received the first shot of the COVID-19 vaccine in January and are scheduled to get their second in February.

“It’s a great opportunity for us to share what we know, so nurses can start their careers with a well-rounded perspective that includes end-of-life care,” said Cynthia Brown, RN, CHPH, HopeHealth hospice’s clinical educator.

“It’s important for them to be comfortable with the subject, to be aware of what happens at the time of death and how to care for people,” Brown said.

Mentored, in-person clinical experiences
Preceptorships – mentored, in-person experience in a clinical setting – are the foundation of clinical undergraduate nursing education, according to Brown.

But COVID-19 pandemic restrictions on visitors to health care facilities have seriously limited clinical placements for college nursing programs. That’s forced nursing programs to scramble to place students, sometimes at the last minute, to ensure they can complete the requirements for their clinical rotations.

Before the pandemic, Salve students were assigned to observe individual nurses on the inpatient unit on designated days of the week for half a semester. The new schedule runs from late January through February and limits Salve students to one visit each to Hulitar, which is undergoing construction to add six more rooms to the 24-bed inpatient unit.

Brown has worked with colleagues to create a schedule that has worked around the construction and accommodated more students for shorter durations. As a result, nursing students come in pairs to shadow a nurse on medication rounds, review the way care is charted in electronic medical records, and to practice using IV pumps.

“It's a beautiful facility,” said Salve senior Allison DeLuca, who spent five hours on a recent Monday at Hulitar. “Everyone was so welcoming.”

Being with patients
DeLuca said that she was happy to see families could be with patients in their rooms during this pandemic. As a precautionary measure, only two visitors can be with a patient in their room at a time. When it appears the patient is likely to pass away within 24 hours, the limit increases to three visitors.

“We talked about how hearing is the last thing to go,” DeLuca said. “The fact that they’re actually allowed to have people that can surround them and talk to them and be with them, I think that’s so special.”

Adaptive learning techniques
In response to COVID-19 protocols, HopeHealth closed a children’s playroom to families. It now serves as a meeting place for the visiting students to meet with staff.

Salve Assistant Professor Julie L’Europa, DNP, APRN, CNP, said that she had to adapt the “Families in Transition: Aging and End-of-Life Care” class she is teaching this semester to include more simulations and labs so students can get enough clinical hours. But nursing students also needed to experience a real-world atmosphere, she said.

“It was great when Cindy [Brown] said that they could take students for the first month but they would come up with this different schedule, which was more than accommodating,” L’Europa says. “I’m very grateful.”

L’Europa started last fall to find clinical placements at assisted living facilities, home care agencies, respite programs and inpatient settings for all 40 nursing students enrolled in her course this semester. Some organizations were reluctant to commit because of the pandemic; she didn’t confirm a schedule for all of her students until an hour after the first class.

“That was nerve-wracking because if students didn’t get 25 percent direct clinical hours, they wouldn’t be able to pass the course and graduate,” L’Europa said.

There was a time when nursing students had very limited exposure to hospice care during their training, Brown explained. Finding a creative way to accommodate the Salve nursing students is important to continue the mission of HopeHealth, which recently started a nurse recruitment drive.

“For me, and for many of my colleagues, we did not learn about end-of-life issues in nursing school,” Brown said. “We might have had one lecture. We’ve come a long way from those days.”

Janine Weisman is the Senior Marketing Communications Specialist at HopeHealth.

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