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Friday August 1, 2014

Rutgers Nursing Schools Aim to Transform Urban Health Care

Rutgers Nursing Schools Aim to Transform Urban Health Care

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Mobile health care program and community wellness center team up to dramatically expand reach

 

Cindy Sickora and Suzanne Willard
Photo: Nick Romanenko
Cindy Sickora, left, and Suzanne Willard, right, in front of the Rutgers School of Nursing mobile health care clinic.

'There is a solidarity among nurses.' – Suzanne Willard, associate dean of Rutgers College of Nursing advance practice program

One Rutgers, A World of Discovery

The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In an online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond.

– The Editors
 
It’s Cindy Sickora’s job to make sure that every weekday, the Rutgers  School of Nursing’s health care van is there to help the people who need it. Its patients, mostly from Newark, are elderly residents in buildings without elevators, gunshot victims in need of follow up care, and children booked for vaccines in a city with one of the nation’s lowest vaccination rates.
 
Many are public housing residents with no health insurance or primary care doctor. Although the traveling clinic treats more than 1,500 patients a year, the city’s need for affordable, accessible health care is overwhelming. 
 
Sickora, an associate professor at the Rutgers School of Nursing, part of the former University of Medicine and Dentistry of New Jersey, was searching for a way to reach more people.
 
She found it when she met Suzanne Willard.
 
On the other side of Newark, Willard had opened FOCUS Wellness Center last fall on Broad Street. The wellness center is part of the Rutgers College of Nursing, which was founded at the university in 1955.
 
Cindy Sickora with patient Tariq Taylor
Photo: Nick Romanenko
Tariq Taylor, left, talks to Cindy Sickora during an appointment at the mobile clinic.
By joining forces, Willand and Sickora hope to accomplish a shared mission: transforming urban health care.
 
Both began working together as Rutgers was preparing to integrate with most of the schools, centers and institutes that made up UMDNJ. Their new partnership allows both facilities to share resources and serve patients far better than they could on their own. For instance, the center has a social worker on staff for patients with mental health needs. The mobile clinic, which has no social worker, can now refer patients to the center.  
 
 “We have the potential to help a whole lot of people,’’ says Sickora, who directs the School of Nursing’s community health program. “Our mobile clinic can make inroads in educating people to use FOCUS, which could be a health care hub, especially for areas of the city we don’t cover.”  
 
Nurses have a reputation for cutting through red tape and getting things done, says Willard, associate dean of Rutgers College of Nursing advance practice program.“There is a solidarity among nurses,’’ Willard says.
 

The center’s first patient was a referral from Sickora. Because mobile clinic staff couldn’t provide gynecological exams at the time, they sent her to FOCUS. “Cindy said, ‘I’ve got someone who’s had problems accessing services and your center would be perfect,’’’ recalls Willard.Days after the visit, mobile care nurses checked in on her at home to make sure her symptoms had subsided. 
 
Newark has one of the most underserved populations for basic health care in the United States. Many residents, who lack reliable transportation, must take multiple buses to see a primary care doctor, if they have one at all. Some wait days, even weeks, for appointments. Others are prescribed expensive medication they can’t afford.
 
Studies show that nurse-managed care can be just as effective as physician-administered care, according to Willard and Sickora. Nurse-managed care is especially successful at providing treatment continuity – as well as a personal touch – at a much lower cost. “Our approach is more holistic,’’ says Willard. “Nurses look at patients and think of their overal ability to improve health outcomes, that’s how we’re wired. We ask, ‘What do I need to do to help them take care of themselves when they leave?’ We want to keep them out of the emergency room.”
 
The FOCUS Wellness Center, funded with federal and local grants, is designed to meet the multifaceted needs of patients who are often grappling with mental health issues and neighborhoods filled with violence, aggravating conditions that are common throughout inner cities: diabetes, hypertension and asthma.
 
Willard recalls one patient who said her father had been murdered when she was 7. “I thought, ‘How can you just treat the physical symptoms with a patient whose father was killed in front of her when she was that young?’ We have a lot of case histories like that,’’ Willard says.
 
The FOCUS staff includes a licensed clinical social worker in addition to students and faculty from the College of Nursing, School of Social Work and the Rutgers’ Ernest Mario School of Pharmacy.
 
As word has begun to spread about the Broad Street center, more walk-ins have been arriving and many have returned. “They tell us, ‘You actually treat us like people,’’' says Willard. That hasn’t always been their experience. … Once you form an emotional attachment, they come back.”
 
Sickora’s staff also has formed bonds with patients since her program, otherwise known as the New Jersey’s Children’s Health Project, began in 2007 with major support from the nonprofit Children’s Health Fund - a national organization co-founded by singer Paul Simon to help children living in poverty.
 
The nursing school’s mobile clinic is part of a larger network, based on a pioneering health care model, in which residents work closely with nurses, says Sickora. The nerve center of the program is Rutgers’ Jordan and Harris Community Health Center, headquartered at the Hyatt Court public housing complex in Newark. It’s staffed by two nurses who make house calls to shut-ins and serve as liaisons between patients and outside health care providers. They also refer patients to the mobile clinic, which makes additional stops in Newark at La Casa De Don Pedro Community Center, serving low-income Hispanic residents, and the Covenant House for homeless youth.
 
Community health workers in Sickora’s program are trained to pinpoint residents in need, schedule appointments and coordinate follow up care. “They knock on doors, they’ll say, ‘We need to make sure the babies get their measles vaccine.’ They’re the reason we’re able to see so many patients,’’ says Sickora, who partnered with Hosseinali G. Shahidi, an emergency medicine specialist at Rutgers New Jersey Medical School, when she applied for funding from the Healthcare Foundation of New Jersey.
 
Sickora and her staff, which includes nursing students, have worked hard to form relationships with residents, many of whom rely on them to treat chronic conditions. 
 
During a recent physical exam, Andrew Jackson, a resident of Terrell Homes, was diagnosed with high blood pressure. Since his Medicaid was cut off last year, he’s made weekly visits for checkups and advice. “They tell me to go slow on the salt,’’ says Jackson, 42.
 
No other mobile health care program in the nation, according to Sickora, uses the community health worker model, which she believes can be a valuable source of data. Researchers from the nursing schools are already involved in evaluating programs. 
 
Says Sickora, “We’re really asking the question: Can we change health care for underserved populations?”

Click here to read other articles in the One Rutgers, A World of Discovery series.

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