Healthy Men and Women Living with AIDS

7/20/2011

Our final class was a blast. We had a big celebration over lunch, with food, and music and decorations. Then, we split the group into men and women and had a separate class for each. I had guest speakers for them on our last day to present our final topic. Lauren Lanehart discussed women's health. She's a fellow Honors student as well as a great friend. Lauren's service learning project involved working in the 1917 Clinic to improve cervical cancer screenings, and she also worked to educate and empower women with HIV. She talked with the Jasper House women about vaginal infection, cervical cancer, abnormal pap smears, and constipation. It was amazing how much the women were able to open up to me and Lauren in private. I couldn't have asked for a better last day with them!  The men went with my fellow nursing student, Adam Turman. He is a great student and friend. He's got lots of energy and is amazing at educating his patients. He talked with the men about adequate nutrition, benign prostate hyperplasia and its risk factors, prostate cancer, erectile dysfuction, and inctoninence. I felt the men needed the opportunity to open up and ask questions to Adam without a female present, so I didn't sit in on this class. However, after Adam left the men came up to me and asked me when Adam was coming back to talk to them again. They seemed to really enjoy his class. Overall, I feel like my service learning project was a great success!

Cognitive Prescription to Improve Memory

7/13/2011

Dr. David Vance has been a major inspiration to me. His articles were a large part of my literature review and academic learning for my project. Dr. Vance is an expert on memory and aging and he has done three studies with adults aging with HIV. People with HIV have a decline in brain volume and cognition. Because the consumers at Jasper House have HIV and mental illness, I believed that it was most important to have every general health education topic be related to improving mental health as well. I had made a list of the classes I was going to teach when I met with Dr. Vance. I told him about my service learning project, and explained that I had very limited resources. I asked him what specifically I could do with the consumers, or teach them that could help them exercise and improve their memory. We discussed the different mnemonic devices, but I was interested in a bigger concept than the techniques such as chucking, method of loci, and the spaced retrieval method. He handed me one of his newer articles Cognitive Prescriptions: A Nursing Approach to Increasing Cognitive Reserve. This article was EXACTLY what I was looking for. It was amazing! The "cognitive prescription" included  physical exercise, intellectual exercise, nutrition, sleep hygiene, social interaction, and mood and emotional state, which were several of the topics of our classes. It was fabulous to be able to use this article to help plan my classes and to sum up my service learning project with the "Improving Memory" class. I created a literature review to be sure all of my classes were very evidenced based, but being able to have most of the class subjects be a part of the "cognitive prescription" made me feel like I was able to really achieve maximum health promotion specifically relevant to their needs.

I don't know if I can say this was the best, or even my favorite class, but at the end of it I felt so accomplished. I was able to purposefully connect all of our classes so far, and review on almost every topic by letting the consumers discuss them. I just felt this was the perfect climactic end to the health education classes I was teaching.

Improving Memory- Class Outline

-This week I prepared a handout instead of a powerpoint, because this class was very much taught through guided discussion.

• Ask the consumers to define cognition
• Discuss what they thought successful aging was
• Discuss and/or review primarily through open discussion the following topics and how they can be positive or negative factors on mental health:
• Physical exercise
• Intellectual exercise
• Nutrition
• Sleep hygiene
• Substance abuse
• Social interaction
• Mood and emotional state

I taught them how to play a memory game with a half deck of cards. Take 2 suits out making sure you are left with 12 pairs, mix them all up and lay them in rows face down, flip one card over, look at it, turn it back to the face down position and continue to do this until you find 2 that match by remembering and locating the current card's match.

Next week, I will not be teaching the class. I plan to throw a party of sorts during their lunch time to show them how much I have enjoyed and appreciated spending time with them. After lunch, during normal class time, two of my UAB nursing student cohorts will be teaching the last class of my service learning project. We will split the 7 women and 7 men up into groups to have a Men and Women's Health class.  Lauren Lanehart, who is a fellow Honors in Nursing Student, women's health extraordinaire, and lovely friend, will be teaching the women. You can see her blog, Healthy Women Living with HIV at http://healthwithhiv.blogspot.com/. Adam Turman is one of my favorite study buddies, a great friend, and was in my med-surge clinical group. He has a really special gift of forming fast bonds with people he meets, and he is fabulous at summarizing difficult information and presenting it in an interesting and understandable way. Adam will be teaching the men's class.


Resource:

Vance, D. E., Eagerton, G., Harnish, B., McKie, P., & Fazeli, P. L. (2011). CNE ARTICLE. Cognitive Prescriptions A Nursing Approach to Increasing Cognitive Reserve. Journal of Gerontological Nursing, 37(4), 22-31. doi:10.3928/00989134-20101202-03

Smoking

7/6/2011

This week, we talked about smoking. The social worker and nurse were very excited about this class. Out of the 14 consumers at Jasper House, 11 smoke, 1 chews tobacco, and 2 do not use tobacco. The class was all about the facts. Fact #1 :75% of people with mental illness  or addictions smoke compared to 22% of the general population. All but 1 raised their hand to the question, how many of you wish you didn't smoke, or wish you never started smoking? We talked about the relationship between smoking and pceople with mental illness. Smoking increases the breakdown of some psychiatric medications, this means the amount of medication has to be increased to be work properly! Quit rates are lower than the general population.

  Why?

- Lower motivation to quit

 -Fewer quit attempts

 -Increased severity of nicotine dependence



I read that the more personal the education is, the more effective. I found a website that calculates how much one would spend on cigarettes in 1 day, week, month, year, and 10 years. http://www.smoking-calculator.com/cigarette_bank/index.php I used this for whoever wanted to know how much exactly they were spending. Most of them were very surprised at how much money they could be saving.

Then we talked about a some of the ingredients in cigarettes and what other things they were used for. Such as:

Cyanide: Rat poison and gas chambers

Formaldehyde: preserving dead bodies

Nicotine: used in pesticides; what causes the addiction

Tar: paves the streets, turns your teeth yellow

Benzene: used to make gasoline

Vinyl chloride: what garbage bags are made of

Acetone: nail polish remover

Lead: batteries, bullets
Ammonia: house cleaner


Then, I gave everyone a piece of paper and a pen and I gave them a quiz (FAGERSTROM TEST FOR NICOTINE DEPENDENCE). I asked the questions as simply as I could. The questions are based on amount, frequency, and time of smoking. Because they have designated times and a limit on how many cigarettes that the consumers can smoke at Jasper House, none of them scored over a moderate nicotine dependence. The scoring ranges from mild, to moderate, to heavy nicotine dependence.


We discussed a few of the consequences of  smoking such as heart disease, stroke, COPD, lung cancer, and head and neck cancer. I showed them some gruesome pictures.


 

Then, we talked about quitting.  There has been a much higher success rate for people with mental illness using specific medications to assist them with quitting, than for the people who did not. Medications DOUBLE their success rate! Nicotine withdrawal can have the same effects as medication side effects and mental illness relapse. I told them about the FDA approved medications including Nicotine Replacement Therapies (NRTs) and the pill medications. I used http://www.becomeanex.org/ to prepare for this part of class. We discussed what actions to take before you can quit smoking, and then how to go about trying to quit. I discussed specific time related health benefits of quitting smoking.

The last fact: Smoking kills those with mental illness FASTER, and more PAINFULLY, because it is a LEADING RISK FACTOR of DISEASE and EARLY DEATH in this population. To end the class, I shared a poem with them:


To Smoke or Not to Smoke by Bill Newbold

To smoke or not to smoke
there is no question about it
whether it is lung cancer or a long life
the choice to choose is obvious.
Life is good, life is great,
life is hard
but much harder when I smoked.
When I smoked I had no time to be in life
so smoking is not to be and is not nobler too.
What a cigarette does hurts
not only myself but the others about.
There are no more places left to smoke in my life
or even in the world at large.
I have decided to ban smoking in my apartment
and so far that has happened.
No one for over two weeks has smoked here.
I can feel the fresh air
keeping me healthy.
Once there was money
to smoke
and time to waste
but now the days are shorter
and my life too.
I can not waste my time
and money
doing something to hurt myself.
I love me
and who I am becoming.
I think therefore
I know not to smoke.
I know not to smoke
so I am an ex-smoker.
I am an ex-smoker
therefore I have become free
of the addiction.
I am free of the addiction
and now it is time
to help others
free themselves from the smoking.

There were lots of distractions this week. In the middle of the class, half of them had to leave. It was hard to keep everyone's attention, especially since this wasn't one of their favorite subjects. I know this is an incredibly important topic, and I really tried to present it in a relevant way, and really mix it up. However, they still did not seem nearly as receptive as with other classes that we've had. After class, I brought out a new bag of goodies. I did not give these away so freely. I bought bags of sugar free candy, sugar free gum, sugar free water bottle drink mix packets, and a big bowl. I put everything in the bowl and showed it to them. I explained the bowl was to "beat their triggers." I would put it behind the front desk (where they go to get their cigarettes), and if they wanted something out of the bowl, they could pick out of the bowl as many items as they would have asked for cigarettes. Some of them were interested, but others flat-out said they would rather smoke. Everyone behind the front desk was really excited about the new intervention and promised they would let all the people from the other shifts know. All in all, this had to be the hardest class so far. Next week is 'Improving Memory,' and I am really excited about it! Wish me luck!

Resources:

Williams, J., Ziedonis, D., Vreeland, B., Speelman-Edwards, N., Zechner, M., Williams, M., & ... Eilers, R. (2009). A wellness approach to addressing tobacco in mental health settings: learning about healthy living. American Journal of Psychiatric Rehabilitation, 12(4), 352-369. doi:10.1080/15487760903248580

Association of State Mental Health Program Directors. (2007, September ). Tobacco-Free Living in Psychiatric Settings: A Best- Practices Toolkit Promoting Wellness and Recovery. National Association of State Mental Health Program Directors. Retrieved July 1, 2011, from http://www.nasmhpd.org/general_files/publications/NASMHPD.toolkitfinalupdated90707.pdf

Alliance for Tobacco Cessation. (2008.). How to Quit Smoking | Steps to Successfully Quit Smoking: BecomeAnEX. Become An EX Smoker, Learn to Quit Smoking, Stop Smoking Cigarettes. Retrieved July 1, 2011, from http://www.becomeanex.org/how-to-quit-smoking.php

Exercise and Immunity

6/29/11
This week, my class was on exercise and immunity. It was definitely the most fun class we've had so far! Instead of a powerpoint, I made a handout with directions for a variety of calisthenic exercises. For the first 20 minutes, I taught them about the benefits of exercise and the different ways exercise can boost immunity. After the lecture portion of class, we  moved on to the exercise portion. I passed out bottled water for everyone. I also brought a CD that I made with upbeat and fast paced, popular music. I made sure the first few songs were a little slower for us to stretch to. Everyone was really hesitant to participate, but once I started the music they definitely loosened up a bit. I asked anyone who could to join me on the floor, and for everyone else to grab a chair and stretch from there. Their social worker normally does an exercise group with them once or twice a week, and she joined us for this part of the class. Most of the exercises that I put on their list were things they could do sitting in a chair, with something simple such as a water bottle or coffee mug to assist with a few of them. I had hoped with the dance music on the CD, that they would want to dance, but I didn't want to make anyone uncomfortable so I thought I'd just let the CD play and see what happened. Well, as we were transitioning from stretching on the floor to getting our chairs ready for the calisthenics, Fergie started to play. Almost everyone just started dancing! It was so much fun. The front desk workers came around and danced with us and the social worker! Half way through the song, the nurse walks in and stares wide eyed at all of us getting down and literally ran to join us! After 3 songs of all of us dancing our hearts out and chanting each other on, we were all out of breath and moved on to the other exercises. We went through the list on the hand out, and everyone was seemed really intrigued at how much of a work out we were getting event though we were sitting in a chair!  After we got done, I passed out granola bars. I feel that this class was a huge success. I hope that I made it fun enough so they will want to exercise on their own more often. I made sure to leave them the CD I made, and I told their social worker that I would make more for them to use during their weekly exercise group. I asked about the evaluations, and they hadn't finished them yet. They are planning on doing that this week.


My resources this week were:

Daumit, G., Goldberg, R., Anthony, C., Dickerson, F., Brown, C., Kreyenbuhl, J., & ... Dixon, L. (2005). Physical activity patterns in adults with severe mental illness. Journal of Nervous & Mental Disease, 193(10), 641-646.

and

http://www.nlm.nih.gov/medlineplus/ency/article/007165.htm

Choose My Plate, Nutrition, Food Labels, & Cholesterol

June 28, 2011

This week class was called Good Eats! We talked about Choose My Plate, food labels, and cholesterol. Again, this class was incredibly difficult to squeeze into 50 minutes. I really wanted to have fun with this class so I brought snacks! I took apple slices, yogurt, peanut butter, and ants on a log (celery with peanut butter and raisins).  Thanks to Heather and Jacquie for the great ideas! These healthy snacks weren’t as big of a hit as I’d hoped.  I asked them what they usually liked to snack on and I got answers like fried chicken and Little Debbie Snacks.  In fact, I was asked if I could bring fried chicken next week!  I used a powerpoint to guide our lecture. After we talked about Choose My Plate, I taught them the basic concepts of label reading. Beth Kitchin is the Nutrition instructor for UAB School of Nursing, and she let me borrow lots of props for class this week. She gave me snack boxes, microwave dinner boxes, juices, soups, and a coke bottle with just sugar in it (great visual to show you just how much sugar you are getting in the 16 oz bottle). I made sure everyone had an example of a food label to hold and read as we talked about them. I brought 5 extra boxes of raisins. I told them that whoever could answer my questions at the end of class correctly would win a box of raisins. This really sparked their attention! One of my students who had been answering all my questions with the word “peaches” and plucking invisible things out of the air told me exactly how many mg of sodium was in the can of soup she was holding, and the daily value percentage. Like Dr. Mc Guinness said, “Perception is an fascinating phenomenon!”  After label reading, we talked about what cholesterol was, and the difference between good and bad cholesterol. This week I got hugs. It was great! I really love my class! 

I won’t be having class next week. The Jasper House nurse will be having a group with them. I’m going to give her some evaluation questions to see what they are learning and what they think of the class so far.  I want to go ahead and evaluate, so that if there is anything I can improve on or make easier for them I can do it now. I’ve got 4 classes left, and I want them to be awesome!

Prevention and Maintenance of Hypertension and Diabetes & Stroke Prevention

June 8, 2011
This week class was called Prevention and Maintenance of Hypertension and Diabetes & Stroke Prevention. I only have 7 classes, so they are very condensed.  After planning for this class, I never thought I was going to be able to fit everything in 50 minutes. I cut it down to the very basics and made handouts. I went to the National Stroke Association website stroke.org and printed out copies of their Stroke 101 Fact Sheet. I also made my own pamphlet for them. I called it “Just a Few Bites on Blood Pressure, Diabetes, and Stroke.”  I decided on its name because everything we were going to be talking about had a lot to do with healthy eating and lifestyle modification. I also used information from the Mayo Clinic and The National Heart, Lung, and Blood Institute.  I made a power point to use in class too.  This class had some difficult information, but I tried to make sure we covered all the basic concepts. My main concern was making sure that the information was relevant to their situation.

Class outline

·         Blood Pressure

o    What is high blood pressure?

o    How do you find out if you have it?

o    Checking your blood pressure

o    Prevention

o    Treatment

·         Stroke

o    What is a stroke?

o    Overview of types and causes

o    Signs of a stroke

o    Stroke Prevention

o    Recovery

·         Diabetes

o    What is DM?

o    Types

o    Risk factors

o    Prevention

Oral Hygiene & Foot Care

June 1, 2011
My first class was on foot care and oral hygiene.  It was called, "Don't Put Your Foot in Your Mouth!" This class was fun to prepare for! All of the dentists who donated were so generous.  I made goodie bags for each student that included: 1 toothbrush, 4 individually packed floss picks, toothpaste, 1 revealing tablet, and 2 nail files. Everyone was extremely grateful for their bag and seemed excited about their new stuff! 

Class Outline for Foot Care and Oral Hygiene:

·         Foot Care

o   Why it’s important to take care of your feet

o   Proper cleaning and drying of your feet

o   Moisturizing your feet

o   Socks and shoes

o   Proper toenail cutting technique and when to let your doctor take care of it

o   Inspecting your feet, having your doctor inspect your feet

o   Diabetes and foot care

o   Common Complication: hard skin, bunions, fungal infections, hammer toes, and corns

·         Oral Hygiene

o   What is good oral hygiene and why is it important?

o   Daily mouth care

o   Proper brushing and flossing techniques

o   Inspecting your gums

o   Dry Mouth

o   Denture Care

o   Common Complications: bleeding gums, white tongue, cracked teeth, cold sore, fizzy drinks and sour foods, bad breath, cracking in corners of mouth, chapped lips