News Archive Articles from MESD News and Other Sources
Nurse Mary Johnson to the rescue11/17/2015
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Lisa O’Toole and Nalani Wineman: MESD Teachers Embrace a Tough Assignment with Grace and Humor12/16/2014 Willamette Falls Medical Center (WFMC) sits on a high bluff in a quiet residential neighborhood in Oregon City. Like other hospitals in the Providence Health and Services system, people come to Willamette Falls to receive critical medical treatment, emergency care, undergo surgery or give birth. For a small population of children and youth, however, WFMC becomes a temporary home while they receive therapy for serious mental health problems. Currently, 22 children, up to age 17, live at the facility while an array of psychiatrists, nurses and social workers try to discover, and dispel, the demons that may propel them into their next mental health crisis. Into this mix have stepped MESD teachers Lisa O’Toole and Nalani Wineman. The team provides an educational program that inserts a bit of normalcy into an otherwise therapeutic and highly structured daily environment. Through a contract with the Oregon Department of Education, Lisa and Nalani make sure the children in the Child and Adolescent Psychiatry Unit continue receiving their education while living at WFMC. With infectious laughter and positive outlook, their patience and expertise replaces dismay, dejection and depression with optimism and opportunity, if only for a few hours each day. Separate strategies for the “smalls” and the adolescents For teaching purposes, Lisa and Nalani have divided the students into age-based groups that require different strategies and approaches. The younger children, ages 5-12, are referred to as the “smalls” by Lisa and Nalani. Though less physically imposing than the older students, they can be more challenging and complex. “We teach the smalls one-on-one,” said Lisa. “They are more intense in their behavior and less regulated. It is mostly boys who are a bit more aggressive. We've had only one girl in that group.” The lessons with the younger children last just half an hour, as that is all they can absorb at one time, said Nalani. The cohort of adolescents, ages 13-17 are taught in a group setting. “We have a table full of big high school kids sitting here waiting for us,” said Lisa. “Some are very outgoing and go off subject a lot.” That dynamic requires lesson plans that must be adaptable to whatever behaviors, or new students, are present on a particular day. Laughter and spontaneity are a major component of their successful approach. “We have a balance of being a little humorous in here, a little silly and then teaching something,” said Lisa. “Our days are half management, half teaching, and half normalizing in here,” added Nalani. As transplants to Oregon, Nalani grew up in Hawaii and Lisa is a Canadian by birth but now holds dual citizenship. They have each worked in a variety of schools and have experience in regular and special education. Before starting at Willamette Falls, they knew each other from working at Doernbecher, Shriners and Randall Children's Hospital as part of MESD’s Hospital Program. They juggle work life with raising teenagers – Lisa and Nalani both have a high schooler and a middle schooler at home. Curiously, both Lisa and Nalani suffered traumatic brain injuries when they were young children - an ironic coincidence which is not lost on them or their students. They live fairly close to each other so they carpool to and from work. This gives them time to debrief the day’s triumphs and failures, what panned out and what fell flat. Some days they go home and admit “that did not work.” That extra time together in the car is is also an opportunity to decompress. “We don’t have time to process here – we are going from the minute we get here,” said Nalani. “We are very sensitive people and sometimes we need self care because we see these terrible situations.” After the first three months at WFMC, they finally feel confident and secure in their roles, but it wasn’t always so smooth, they said. As with other programs MESD operates in detention facilities and hospitals, the population of students can change daily. Starting a new program with students who are transient – they may stay up to 45 days or just for a week or so – is challenging. “There is so much involved in this job. You are a teacher and there is the therapeutic component and then you have EPIC (the medical records system) and you work with the doctors,” said Lisa. “It is such a multi-disciplinary field – I know teaching in regular schools is too, but this is a different beast,” she said. “We have seen growth with the smalls and it’s a beautiful thing, especially from the special ed perspective because their emotional problems have affected their ability to act in an appropriate way in school and that is why they are here,” said Lisa. The adolescents are a totally different challenge. “When I first came here, the adolescents scared the living daylights out of me. I was used to the smalls,” observed Lisa. “But Nalani was unfazed as she drew on her experience in a resource room in a Portland Public high school.” Now they have reached a comfort level that allows them to interact seamlessly with children of ages as they laugh, tease and teach. Returning to a supportive home is rarely an option Sadly, they know the reality for some students is not full of promise and rehabilitation. Most children in the unit face an indeterminate future of foster care or a return to dysfunctional family life. At times, the doctors and nurses will speculate that a particular student is sure to be re-admitted to the unit somewhere down the line. Some of the children have experienced verbal, physical and sexual abuse. It’s like a horror movie, they said, listening to stories about police coming in the middle of the night to take away their parents or siblings. “Our students might be homeless, living in a car, coming from juvenile detention,” said Nalani. “We have kids who have been taking care of their families at a young age.” Patrick McArthur is the supervisor of the program and speaks highly of Lisa and Nalani. "I am very impressed with how well the Willamette Falls staff work together to plan, evaluate the effectiveness of their lessons, and ensure their students are able to relax in the positive and supportive classroom they have developed. The students in their classes have very significant mental health needs and need highly motivated and skilled teachers," he said. "Since the first week of school, they have worked to learn and improve every facet of their program. I couldn't be anything but pleased with their accomplishments this year." Their classroom – a work in progress Because the unit recently moved to WFMC, the physical environment in which they teach is not yet optimal – they need bookshelves, a classroom phone, a separate office and access to the medical records system – but they are making the best of the situation. As the medical staff of WFMC have adjusted to their daily presence, a real sense of teamwork is emerging. They start each day taking part in the medical rounds where there is in-depth discussion about the children and input is gathered from a variety of perspectives. “We feel like we do a good job here…we connect with these kids. We’ve had a nurse say the amount of restraints and lock-downs have gone down,” they commented. “It’s all about success in here for me - that students are successful and spent the hour at least feeling a little bit normal, doing something to keep the brain going,” said Lisa. Josh Hurd & Deb Deluca10/1/2014 Eight-year old Josh Hurd is a handsome young boy, with dark hair, beguiling eyes and an inquisitive look. As a second grader, he attends Seth Lewelling Elementary School in the North Clackamas School District where he is surrounded each day by classmates, many of whom have known him since kindergarten. He loves to read, go roller skating and take trips with his grandparents. Josh also has SMA, or spinal muscular atrophy, which has deprived him of his physical strength and taken away his ability to walk, eat or breath on his own. That’s where MESD’s one-to-one nurse Deb Deluca comes in. Deb is Josh’s lifeline to the world of education, as well as his friend, teacher and daily companion. Deb has been caring for Josh since he was seven months old. By becoming familiar with Josh’s facial expressions, his eye movements and other subtle cues, Deb knows his wants and needs intimately. She enables him to attend school every day. Despite what most people might see as his profoundly-limited physical capacity, Deb focuses on what Josh can do – not what is out of his reach. “I want people to see his abilities, not his disabilities,” said Deb. During a visit with Josh at Lewelling, Deb explained how medical technology allows Josh to attend school with his friends and get the education that he deserves. Rather than sitting at desk or table, Josh reclines in a special chair to which is attached a ventilator, a cough assist device, a gastronomy tube, and a heart rate and oxygen monitor. All this apparatus is required to keep Josh alive – but it also allows him to thrive in his classroom. According to Deb, his condition does not affect his immune system and Josh did not miss any school days last year due to illness. Deb also has a little wagon in which she stores an extra oxygen tank and an ambu bag for manual ventilation if needed. And all the while, Deb is at his side – every minute of every day. She is ready to suction his saliva when it accumulates in his mouth or to read to him or to prepare his g-tube with a specially prepared nutritional mix that is made from scratch. To his friends in second grade, Josh is different for sure, but he is still fully integrated into almost all classroom and school activities. Deb says that other students in his class speak up for Josh and “never leave him out.” “They are his advocates,” Deb said. A career in pediatrics Deb Deluca has been a nurse for over 30 years, always in practicing in pediatrics. She has also provided home care for children with disabilities. That's how she came in contact with Josh when he was seven months old. Caring for children with severe disabilities is a life calling for Deb. She is fully committed to Josh, as she has been to many children with whom she has worked over the years. “I love it because I can make a huge difference,” she confided. Deb relishes the professional opportunity to be a “voice” for students whose fragile medical conditions may diminish their participation in school and life. Prior to working at MESD, Deb was a nurse at Emmanuel and Good Samaritan hospitals and with Portland Public Schools. She has been with MESD since 2004. Deb appreciates Josh’s very supportive family, including his grandparents who take him and Deb to activities in their van. His favorite activity is to go roller skating – Deb gets on some skates and pushes Josh in his specialized stroller. He also spends some time in the LEEP classroom operated by Clackamas ESD. Josh will soon have a new assistive technology tool to used for communication that uses “eye gaze” technology, said Deb. Eye gaze technology is an eye-operated communication and control system that empowers people with disabilities to communicate and interact with the world. By looking at control keys or cells displayed on a screen, a user can generate speech either by typing a message or selecting pre-programmed phrases. Although Deb may spend up to seven years with an individual student, she knows that at some point, both her student and herself will have to move on. “I don’t want my student to be too dependent upon me, but rather be as independent as possible,” she said. That means that at some point, as Josh gets older and goes into high school, Deb will step away from her current role and hand that responsibility off to others. Deb draws praise from MESD Supervisor Christy Fawcett “Deb has been a one-to-one nurse for over 20 years and has worked in a variety of settings from acute intensive care to the school setting. Deb is highly skilled and always has students with the most complex of health needs,” said Christy. “Deb practices using a holistic approach and recognizes the abilities and strengths of every child she encounters. Deb brings amazing nursing skills along with the heart and soul of a truly gifted person. When I am looking for a nurse to teach others on ventilator skills and how to manage this type of medical technology in the school setting, Deb is my ‘go to’ nurse. MESD, our students, families, and faculty are very fortunate to have Deb as a member of our team,” she said. According to Christy, there is a unique skill set that MESD looks for in one-to-one nurses. “We look for a nurse with strong technical, communication, and organizational skills. We also look for a nurse that can work in a variety of settings and with minimal direct supervision. Our one-to-one nursing team is flexible and creative as they work in a variety of settings from general education classroom to a trip to the zoo.” Currently MESD has approximately 36 students attending school with a one-to-one nurse. Several students who attend are ventilator dependent and attend with a nurse that is highly skilled in the complex management of ventilator dependent children. MESD has one-to-one nurses in five Multnomah County Districts. MESD also has one-to-one nurses working in many districts in Clackamas County. One-to-one nurses provide care in the early childhood programs all the way through the post-secondary programs. |
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