Centers of Excellence Primary Care Education
The Week's BLAST News Links November 21, 2012
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CoEPCE Site Highlight
Spotlight on Jonathan Van Nuys, NP CoEPCE Trainee in VA San Francisco EdPACT featured in New Documentary on Nurses.
Story by Christa A. Garcia, CoEPCE Coordinating
Jonathan Van Nuys, who was once a film critic for local newspapers in his hometown, was recently featured in a documentary known as “Nurses: If Florence Could See Us Now.”
The film showcases the diversity and power of nursing while reaffirming the pride and joys of the profession. In the film, Van Nuys tells an inspirational story about a nurse named Laurie and how she impacted Van Nuys and helped him to develop the insight necessary to view his health challenges as a tool rather than a crutch. His experiences gave him the motivation to redirect his life through advocating for those in need and helping others during their most vulnerable times.
Growing up in Sonoma County, Van Nuys had always been family oriented. His parents, brothers and sisters were supportive throughout his life, emphasizing his belief that continuous support systems are essential to any person’s well-being. When Van Nuys was diagnosed with HIV, he felt stigmatized and trapped in secrecy and became reclusive from family and friends. Van Nuys turned to his personal primary care team as his major source of support. Later, when he was diagnosed with stage IV testicular cancer, he was forced to move back home to his family, but continued to keep his HIV diagnosis a secret. He knew intuitively that his family would continue to love and support him, but self-blame and guilt took an emotional and physical toll on Van Nuys.
At the hospital, Van Nuys met a nurse named Laurie. Laurie helped Van Nuys to reevaluate his outlook on life. Laurie saw that Van Nuys was regularly visited by loving and affectionate parents and family members. She encouraged Van Nuys to stop distancing himself from his caring support system and suggested that he share his HIV diagnosis with his family. Laurie also stated that if her own son shared a diagnosis of HIV, she may experience various and normal emotions but ultimately she would continue her love and support. Laurie then gave Van Nuys a bracelet to symbolize the strength and support of his healthcare team and to serve as a reminder that this support would continue when he was ready to reveal his secret. He drew energy from that moment with Laurie and found relief from the burden that he had been carrying. This heartfelt gesture and Laurie’s insight helped Van Nuys reevaluate his situation and change his perspective. Through this change, his intrapersonal distress improved and he felt able to reconnect with his family. His diagnosis now gave him a sense of purpose. At that point, Van Nuys decided to become an advocate for HIV/AIDS and to make a difference in the lives of others, very much how Laurie had made a difference for him.
Today, Van Nuys is a 2nd year nurse practitioner (NP) trainee at the San Francisco VA Medical Center (SFVAMC) pursuing his Masters in Nursing, specializing in HIV/AIDS at the SFVAMC affiliate, University of California, San Francisco (UCSF). He is participating in an interprofessional team training program and the Center of Excellence Primary Care Education (CoEPCE) (known at the San Francisco site as “EdPACT” (Education in Patient Aligned Care Team). Through PACT (VA’s version of the medical home model), Van Nuys is gaining valuable experience in healthcare transformation. He has been able to build strong relationships with not only his preceptor and fellow nurse practitioners but with other members in his team outside of his own profession.
Van Nuys believes that these relationships help team members gain a sense of value and respect for each other’s professional role in daily operations and especially in the delivery of patient care. He reported that each individual comes together to create acohesive team, communicating with one another to ensure overall quality care. He went on to state that within the CoEPCE and PACT, Veterans have continuity of care and access and a familiar, personalized healthcare team who can support them throughout their lifetime. Van Nuys noted that the program felt contrary to traditional healthcare models where primary care physicians sometimes make solitary decisions.
Van Nuys has reported a steep learning curve in his EdPACT training program, but he also believes that this learning and teamwork are vital to success and necessary for healthcare transformation. He also noted that this cross-profession exposure improves the healthcare delivery system as trainees and other professionals continually gain knowledge from shared teaching and learning. As a Nurse Practitioner training under this innovative model, Van Nuys feels very much the pioneer in this new system of care. He stated, “I think this care model is the wave of the future”, he went on to reflect that “it took a team of support (personal and professional) to help me to get where I am now.” With his EdPACT team members comprised of nurses, a social worker, a nutritionist, pharmacist, psychologists and others … he said “I think patients really benefit in this wrap around care.” He went on to say, “One of the things that has impressed me about the EdPACT model is that every team member has a voice in the huddle and is empowered to better care for the patient.”
Van Nuys has found that each day is memorable with the Centers of Excellence and believes that the training received by incoming professionals will be carried throughout their lifetime. He reflected on the strategies of the program towards reforming the patient care delivery system and believes in large part that patient centeredness, respect and compassion is vital to healing and health. One of Van Nuys’ patients stated, “Every time I come into the VA, I am impressed with the humanity that each person (in my team) shows to me because (in my experience) that was a very rare thing in medical care.”
As a trainee, Van Nuys feels that he is very much a part of the VA PACT team. Although initially intimidated by the demands of the program (in comparison to his previous learning experiences) he feels respect from VA staff and his team members and has been given support throughout the program. Now, he explains, every trainee has access to a great network of mentors, inside and outside of their profession, such as preceptors, staff physicians, nurses, pharmacists and more compared to the traditional clinical rotations. Van Nuys stated, “I feel like I’m at the cutting edge of primary care medicine.” “I’m learning the best tools and techniques and I’m learning the best model of team based care which is important to me in my own life and healthcare needs.” He said “It takes more than one person; it takes a team of expertise and this is a complete training program.” He indicated that training includes not just those important clinical activities, but it expands the dimension of learning through regular conferences and projects based around formal quality improvement strategies. He has been especially pleased with the varied presentations and diabetes board sessions, and believes the program to be a fully immersive learning experience. “I really feel like it is the best training that I can have this point of my career.” It is a privilege to be here.” said Jonathan Van Nuys.
The film Nurses: If Florence Could See Us Now” debuted at Regal Cinemas LA Live Stadium in Los Angeles in October. To view the trailer: Nurses: If Florence Could See Us Now
West Haven Center of Excellence, Primary Care Education Televises Interprofessional Education Program during COE Ambulatory Care Nursing Grand Rounds via Region 1 Scan Echo Telehealth Education
Scan Echo (the Specialty Care Access Network-Extension for Community Healthcare Outcomes) is VA’s model for promoting innovative specialty care access and provider education through video-teleconferencing.
This process links multiple sites in different communities and supports opportunities to share educational resources and specialty expertise. In a new endeavor for the VA Connecticut Healthcare System, Centers of Excellence, Primary Care Education (CoEPCE) Co-Directors Sue Zapatka, APRN (Pictured Right) and Rebecca Brienza, MD of the West Haven site are leading the development of an interactive, video-broadcasted interprofessional education at rural and remotely located CBOC’s (Community Based Outpatient Clinics) and (shortly) other clinics in VISN 1. This program will provide RN’s and other health professional’s opportunities to participate in CME accredited education and improve interprofessional practice and patient-centered delivery systems.
West Haven’s innovative new program will occur monthly as a one hour session consisting of topic overview, followed by a didactic, case presentation and discussion. The focus of the program is in supporting RNs in a medical home based/PACT (Patient Aligned Care Team) environment and to provide a mechanism for them to collaborate and standardize triage protocol supporting non-life threatening and life-threatening processes for care through interprofessional education and learning. CoE residents and other disciplines are enthusiastically planning to participate. As part of their learning experience, each NP fellow in the program will be expected to lead a discussion during the tele-education sessions. Sue Zapatka believes this is great opportunity for nursing and that this activity will help to “set expectations for future VA trainees in multiple disciplines leading to interprofessional collaboration in the future.”
Wendy Bellmore, APRN, Program Coordinator Region 1 VA Scan Echo is interested in sharing this program throughout VISN 1. Wendy and Pradeep Mutalik, MD, QA/Outreach Coordinator Region 1 VA Scan Echo have offered the possibility to transform interprofessional education while economically reaching a larger number of attendees. For employees who were unable to attend, sessions are recorded and downloaded to the VA’s Scan Echo Sharepoint website for future reference.
Christine Kennedy, MSN, RN, Hospital Education Instructor, Region 1 Scan Echo Nurse Educator and ANCC Nurse Planner has obtained CME for all nursing attendees. The goal is to obtain CME’s for physicians, pharmacist, health psychologists and additional disciplines in the future.
On November 7, 2012, the first presentation featured West Haven CoE’s trainee, Sarah Dann, APRN, and her topic “Triaging Angioedema .” The outcome of this first program was outstanding. Patti Pitkin, APRN, Firm A Nurse Manager states, “Sarah did a wonderful job. Go CoE!” She offered her thanks for a well planned program and went on to say that the program provided great information and that “everyone learned something.” CBOC nurses further reported that this “Nursing Grand Rounds was well presented, useful review of important information” and was a “Wonderful Nursing Grand round presentation.” Thanks were offered for the opportunity to advance in knowledge and skills and trainees and staff felt that it was fun and important to be able to communicate and share knowledge with remote colleagues.
December 5, 2012, the program focus will be on triaging abdominal pain. Presenters will include CoE NP Fellow, Ronald Castillo, PGY3 Resident, Theodore Long and PGY2 Resident, Trishul Siddharthan.
Coordinating Center Staff