StemCell Therapy

Editors note:The nurses interviewed in this feature are former recipients of the Mpls.St.Paul Magazine Outstanding Nurses Award. We are grateful for their time and input for this feature.We are in the process of outlining our approach to this annual editorial initiative. Please send an email tooutstandingnurses@mspmag.comto let us know you would like to receive details once we are ready to move forward.

Time is of the essence when you find yourself in an emergency situation.

Just ask Kathleen Koivisto, an in-flight emergency medicine nurse with Life Link III. She doesnt waste any time when the helicopter carrying her and her team lands at the scene of an accident.

She quickly gathers all the needed suppliessuch as airway bags, a ventilator, sometimes an ultrasound, and protective gear to help keep patients safeto prepare or intubate a patient before putting them in the helicopter for the ride of their life to a level-one trauma center. But now with COVID-19, theres an extra, critical step. Before Koivisto can interface with first responders for the handoff of the patient, she must also put on all the necessary high-level personal protective equipment (PPE) to ensure she keeps herself and those around her healthy and safe. We wear masks, gloves, and eye protection with all patients. With suspicion for COVID or COVID-positive patients, we add Tiger masks or N95 and gowns. It all depends on what symptoms the patient presents.

Taking the time to put on the added PPE can be tense when a patient needs immediate attention. If youre watching a monitor and their vital signs are junky . . . it feels long, Koivisto says. A couple minutes is a long time in an emergency. Nobody has suffered because of this vital extra step, except maybe Koivistos nerves.

Not all of her patients are accident victims. Some need transport from rural hospitals to major medical centers for specialized neuro, cardiology, and trauma care. Still, COVID protocols are essential. Patients who dont require a breathing tube but are COVID positive can be transported with a Sea-Long Helmet. This allows us to give them oxygen and support their breathing without exposing the transport staff and others to the virus.

Our pandemic-filled world is testing nursesfrom administrators and educators to those on the frontlines in ways they never could have imagined when this year started. And thats saying a lot, since some of them have been doing their jobs for decades.

We talked to seven nurses who shed light on their lives and their profession during these unprecedented times.

Kristin Lau, a public health nurse in Ramsey County, works with first-time mothers, and an important part of her care strategy is visiting them in their homes. She makes house calls from the time theyre pregnant until their child is 2 years old to ensure everyone stays healthy and progresses as they should. However, since March, shes needed to turn these visits into virtual ones.

Now, instead of hopping into her car and listening to some relaxing music to clear her head between home vis- its, Lau engages with her mamas, as she affectionately refers to them, on Zoom, Microsoft Teams, and Google platforms. A day of several back-to-back virtual visits can leave her feeling extra tired. Theres a study that says it takes a lot more energy to engage over Zoom for one hour than it does in person, Lau says. I think its something like it takes three times the energy.

However, shes thankful to have the technology so she can stay engaged with the women she cares for and get a chance to still see them moving about their lives at home. Lau is always on the lookoutmonitoring her pregnant mamas for any visible signs of distress. For example, one client who was 37 weeks pregnant showed signs of preeclampsia, a life-threatening condition for both mother and baby. As soon as she popped up on my screen I could see her face was quite puffy, Lau recalls. After asking her client a series of questionsAre your hands swollen or tight? Do you have a headache? Hows your visionblurry, seeing spots? Any dizziness?she had the expectant mother check her blood pressure using the cuff thats provided by Ramsey County. Lau

knew this woman had to get medical help right away. She delivered the baby about six hours after she went to the hospital, Lau says.

As a nurse who does home visits, Lau has always had a unique portal into the personal lives of her new mothers, which helps her advise and care for them. And now, with Lau working from home, these new mothers are getting a glimpse into hers. Lau has five childrenages 9 to 20three of whom are doing distance learning at home. Plus, her husband, who has a preexisting health condition, also works from home. So thats five people, plus a couple of pet dogs, jammed into their home. Lau has set up a private room for her meetings, but that doesnt stop her clients from hearing her kids loudly engage with their siblings in another room and her dogs barking at the Amazon truck. I think its almost relatable to them to see me in the mother role, Lau says. It brings them joy.

We think about this cohort of students now in the academic programs. Theyll be the first nurses to be educated about this type of pandemic worldwide. Theyve studied and learned about pandemics in other countries, but its at a distance. Its not us. But now its here, and were living it, and were not doing so well either. Susan OConner-Von, associate professor, University of Minnesota School of Nursing

College campuses, such as St. Catherine University, have also taken to making virtual house callsbut in this instance on students. One evening back in March, Jocelyn Bessette Gorlin, an associate professor of pediatrics in the school of nursing, was teaching an advanced nursing health assessment class. That same night, the school announced it was closing the next day due to COVID-19. In the week or so leading up to the announcement, Gorlin had gotten a jump-start and had connected with the schools IT department to learn how to record Panopto videos, a kind used in the field of education, just in case the school transitioned to e-learning. We asked ourselves: How can we teach hands-on assessment skills remotely? she says.

After class that March evening, Gorlin, along with other faculty members and teaching assistants, formed an assembly line and filled Ziploc bags with the tools that the graduate students would need to practice their skills at home (tongue depressors, reflex hammers, pen lights, and more). When a ship is having trouble, you get on this raft and you do what you have to do, Gorlin says.

As it turns out, they learned they could do quite a lot. Within one week, students recorded their first video demonstrating health assessment skills on people with whom they were quarantined, such as their children, parents, and roommates. (One student who lived alone formed a mannequin out of old clothes that she beautifully assessed, Gorlin says.) Gorlin witnessed her students listening to their childrens heartbeats and gently assessing parents abdomens. The recorded videos gave us a glimpse into their home lives, she says.

Gorlin also used Google Meet and Sammy, a 140-pound medical mannequin from the school of nursing that wound up lying on her dining room table, to interface with students and offer feedback on how they could improve their assessment of a patient. Google Meet also came in handy when she held virtual lab sessions three times a week from her home. Gorlin enjoyed demonstrating how to do cranial nerve and musculoskeletal assessments on her roommateher husband, a hematologistwhod sometimes provide comic relief by swing dancing instead of sitting quietly for his checkup.

In the fall, Gorlins students returned to campus for classes on a part-time basis. While Panopto videos and Google Meet were part of the syllabus, so were small face-to-face lab classes that alternated with synchronous virtual sessions connected via technology and teamwork. At the start of class, students get their temperature taken and don gloves, masks, and face shields before meet- ing up with their assigned partner, whos wearing a plastic three-by-four-inch name tag with their picture on itas all of the PPE makes the faculty and students unrecognizable.

The teamwork Gorlin witnesses, along with the use of technology, seems a little NASA-like to her, as students depend on each other to maintain health and safety while also promoting new state-of-the-art technology that will benefit people and health care. Were in different spaces, we have high-tech technology, and were connecting remotely. Even though its estimated that this sort of hybrid teaching model takes educators about one and a half times longer to prepare and to teach, its worth it. Were preparing them to be on the frontlines, Gorlin says. So were on the frontlines to put them on the frontlines.

As of press time, in Minnesota alone, 157,096 people have tested positive for COVID-19, and 15,022 have been health care workers.* Given the state of the world, some educators thought that enrollment in nursing programs would decrease. However, enrollment in the nursing program at the University of Minnesota School of Nursing has remained steady and increased in some cases. Ive always been impressed with students, but especially now with their deep desire to become nurses in the midst of a pandemic, says Susan OConner-Von, a full-time faculty member at the University of Minnesota School of Nursing, whos been in the profession for more than 40 years. I think we were nervous. Will anyone come back, you know? Who would want to become a nurse during this time? Im just so impressed with their motivation, with their dedication, with their desire to help others.

OConner-Von and her colleagues have discussed the unanticipated experience nursing students are having right now. We think about this cohort of students now in the academic programs. Theyll be the first nurses to be educated about this type of pandemic worldwide, she says. Theyve studied and learned about pandemics in other countries, but its at a distance. Its not us. But now its here, and were living it, and were not doing so well either. This cohort of students are going to be so uniquely prepared because they have the lived experience.

During the early months of the pandemic and the social unrest that soon followed, when many of Gorlins students expressed their concerns about what was happening all around them, she set aside time when they could connect with her one-on-one. Id say 80 percent of our conversation focused on them questioning what was right in their career going forward and how they were going to do it, she recalls. Her advice? What I kept saying to the students was, This is not the journey you expected. But youre still marching forward. Youregoing to have a different step, and youre going to have a different pace to the march, but youre still moving forward, and youre going to be more resilient because of it.

My hope is that people will recognize how devastating underlying conditions can be. A silver lining to this pandemic would be if this changed peoples perspectives on health and they made lifestyle choices that improved quality of life and improved resistance to disease. Kathleen Koivisto, in-flight emergency medicine nurse with Life Link III

Michelle Curley is the director of nursing for home health agency and infusion nursing at Pediatric Home Service, and she sees this kind of resilience and desire to help firsthand. In her area of speciality, nurses travel to families homes to administer IV therapy to children. However, because these patients are especially susceptible to illness, nurses need to be extremely careful. So when a nurse has even one symptom from the CDCs long list of potential COVID-19 symptoms and has to be quarantined until tested, another nurse will readily step in to avoid having to send the vulnerable child to an infusion center. So far, eight nurses (out of 14 nurses on the team) have had to quarantinethankfully, none of them have tested positive for the virus. Two have gone on maternity leaves during this time. This can make things extra challenging. People have hardly taken PTO because everybody is trying to cover for everybody, Curley says.

There are some treatments, such as intravenous nutrition, that nurses can teach parents to administer to their children without having to leave the safety of their homes to learn how to do it. Pre-pandemic, parents and caregivers would travel to the hospital for up to three days of instruction. After hospitals went on lockdown, nurses traveled to clients homes to teach families. Now one nurse is fully dedicated to doing this training for some treatments virtually.

Of course, young patients love to see their nurses familiar faceespecially in the comfort of their home. However, these days, it can be hard to see that friendly face when its covered in PPE. To put their young patients at ease, and to get some giggles, nurses get creative and will draw eyelashes and lips on their protective goggles and face shields.

Due to a shortage of face shields during the first month of the pandemic, Curley and her crew made some from plastic, foam, and Velcro. Today theres enough PPE for all her nursing staff, and Curley wants it to stay that way. To help manage its supply, Curleys office puts it on lockdown, allowing nurses to grab only what they think theyll need over a set amount of days.

During these past nine months, the nursing profession has proven it can pivot with how nurses deliver care to patients. And they do so remarkably well. Mari Holt, vice president of clinical operations at Allina Health Mercy Hospital-Unity Campus, says one of the biggest challenges nurses continue to face is the vital yet complex layering on of head-to-toe PPE protection when engaging with COVID-positive patients or patientswhose COVID-19 status is under investigation.

This isnt Holts first experience with a health crisis that required such a high level of protection for staff, however. Back in 2014, when the Ebola crisis hit, she was part of a front-line team that not only helped Unity pre- pare for patients but also worked with three patients who may have been impacted by the virus. But Coronavirus is far different, she says. As a facility that received patients under investigation for Ebolathat was on one unit, she says. The PPE was similar but it was one person on one unit, not 18 patients on the same unit requiring multiple staff to care and be gowned up each and every day throughout the entire shift.

The Unity Campus has different wings and depending on patient volumes, it can have patients under investigation in one wing and COVID-positive patients in another clearly delineated zone. While working in a COVID zone allows nurses to go from room to room and conserve PPE, as all of the patients on that unit are positive, Holt notes, the challenge for the nursing staff is being in the equipment all of their shift. With Ebola, staff would come out of the room and be able to remove their PPE.

When asked how her teams are managing the stress, Holt notes the emotional challenges that accompany being a frontline care worker are very real. Nurses man- aging patients in isolation help anxious families juggle care strategies and telehealth-type visits. Even at a time when patients can have compassionate care visitors, she says, many family members do not want to come and visit their loved one if they have COVID. At times, she notes, nurses are the only person holding the patients hand and spending time with the patient as they take their last breath.

Nurses as a whole also experience an insiders perspective of the health disparities among underserved populations. This fact takes a toll on nurses emotionally. Lisa Sundberg, a nurse care manager who cares for home- less vets at the VA Community Resource and Referral Center in downtown Minneapolis, sees firsthand how the pandemic has affected the homeless population. According to Sundberg, some veterans deal with feelings of isolation alreadyfeelings of being cut off from other people, a loss of relationships, employment, and financial security. Homelessness increases the stress.

When the pandemic reached Minneapolis, many of these vets, some of whom have mental health illnesses, feared for their lives. The veterans were scared to death, Sundberg says. My heart went out to them. They have nothing. Theyre like, At least people have a home to go to and isolate.

Thankfully, the center is a safe haven for those in the community offering medical triage daily for trauma and medical illness, vaccines, COVID tests, and primary care for nearly 300 veterans. Its also a place for thosein need of a warm shower, a place to do their laundry, or a bagged lunch. The staff preaches the importance of handwashing and social distancing. They provide masks for their clients, but many are already wearing one when they enter the building. Also, the center helps these folks connect to other social services nearby, such as homeless shelters like Exodus, Salvation Army Harbor Lights, and House of Charities. Recently, a homeless vet who spent time with an asymptomatic friend who tested positive for coronavirus isolated himself for 14 days in his own room at one of the shelters.

Nurses are so dedicated to their patients, OConner-Von says. They have this strong sense of duty. Back when I worked in ICUs, we would have times where wed be really busy for a week or two. Wed be working double shifts, working all weekend, picking up extra time. But then after several weeks or a month wed get a reprieve. And you could maybe take that day off. This has been going nonstop since March. And so that feeling of exhaustion must be overwhelming. Not only for the patients and families but for the health care professionals.

I think about those administrators trying to support their staff and somehow do self-care and provide emotional support in whatever way they can.

Being the natural caregivers that they are, nurses often want to extend their hand to everyoneincluding their loved oneswho may be struggling. But it can be difficult to do so when theyre stretched so thin. Oftentimes this results in feelings of guilt and putting themselves on the backburner. OConner-Von uses these insights and examples to teach her nursing students that caring for themselves is also part of the job. She gives extra credit to those who take the dog for a run, read a book they dont have to underline, or call a close family member or friend just to catch up so self care becomes a habit. You cant go in burned out and provide compassionate care, she says.

Nurses try to remain hopeful and optimistic about the future. However, many are wondering how people will fare this winter, when the flu is added to the mix. Were all a little on edge, Sundberg says.

In addition, the sheer magnitude of trying to drive home the seriousness of this disease can feel overwhelming at times. Lau educates her families about the signsand symptoms of Coronavirus and where they can get a free test. Im in public health so were trying to keep our public healthy, Lau says. So it feels like a big responsibility.

She tries not to allow the heaviness she feels at times to overwhelm her. Though she admits its easy at times to get tied up in ... your own chest and in your own stress. Thats when she reminds herself that things are going to be OK and puts something on the calendar that she can look forward to, even if its just a Friday night date at Costco with her husband.

Lau says the number-one lesson they taught in nursing school was the importance of being adaptable and flexible. Never has that proven more true than it has in 2020, a year that we will never forget. Lau likens her role to being a wartime nurse. The battlefield has changed, she says. Our battlefield is our community, our grocery store, our hospitals, our schools. Were all trying to combat this [disease] and were all in this together.

As with any warfare, tactics evolve to ensure peoples safety and care. We are all adapting to be flexible, Holt says. Communication is key as things have changed, and continue to change, as we learn more about the disease. It is challenging to keep up with the changes, which is imperative for our bedside staff.

The CDC reports those with certain underlying medical conditions have a greater chance of becoming severely ill from COVID-19. Of course, not all underlying medical conditions are manageable. However, Koivisto believes that if people become more cognizant in caring for their overall health it would give them a better chance of combatting health setbacks. My hope is that people will recognize how devastating underly- ing conditions can be, she says. Many of these can be lessened with lifestyle changes like clean eating and exercise. A silver lining to this pandemic would be if this changed peoples perspectives on health and they made lifestyle choices that improved quality of life and improved resistance to disease. It would be amazing to see more Americans use food and exercise as preventative medicine to help decrease the impact of diseases like COVID and others.

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Nurses Reflect on Being at the Frontline of the Coronavirus Pandemic - Mpls.St.Paul Magazine

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