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A Gateway for Learning
   
   
Spring 2008  
       
   
     
 
   
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A Gateway for Learning
By Dana Goldman

 
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Many of the patients look 20 years older than they actually are—and have symptoms to match. Others are depressed and have turned to alcohol as medication for both physical and emotional pain. Most can only guess where they will be in seven days or seven weeks, making follow-up appointments out of the question. Few have much control over what they eat, surviving off soup kitchens and scavenged food.
     Health problems facing the homeless are severe and can severely strain health care professionals unfamiliar with the population. That's exactly why Emory's nursing school is providing its students with practice, through a collaboration with the Gateway Homeless Services Center in downtown Atlanta. Populations like the homeless call for a different kind of nursing, one that Emory's nursing students are learning how to provide.
 
         
      The Great Demand

Johnny Hogue, 52, spent eight months living at Gateway after becoming caught in a downward spiral that included the deaths of his mother and wife, a long-time addiction to drugs, a job loss, and heart and back surgeries. "I have seen guys come in here from divorces after they've lost their homes," he says. "There's a guy here whose family had a car wreck. They died, and the medical bills took everything he had. And addiction's a big reason a lot of folks are here."
     Now, Johnny's been clean almost two years, and he gives Emory's collaboration with Gateway much of the credit for his physical, emotional, and spiritual good health. He is just one of many success stories of the Gateway collaboration, which started in 2005, soon after the center's opening. "Some of the clients who have left have made a point to call and thank Emory students and faculty for what they've done," says Gateway client engagement specialist Vicky Ford. "They've learned to trust them."
 
     
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Monica Donahue
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It appears the experience for many
of the students is very transformative. It changes the way they see and understand people who are homeless.
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—Monica Donahue
 
  In Charge and Charging forward

At the helm of Emory's effort is nursing instructor Monica Donohue. Since the beginning, Donohue has coordinated Emory's partnership with Gateway: arranging rotations and health fairs, assessing the needs of clients, and talking up Gateway to faculty and students as a unique service-learning opportunity.
     She also has been witness to Gateway's own learning curve. "It's definitely changed a lot in so many ways," says Donohue now. "They have grasped their identity as a service center, not just a homeless shelter. They don't want to be seen as a short-term answer but as a big part of ending chronic homelessness."
     That's where Emory comes in. Early in the collaboration, Donohue saw that Emory's nursing students could fill a vital role at Gateway by complementing the on-site primary care clinic operated by Saint Joseph's Mercy Care Services. During the fall 2007 semester alone, 10 groups of Emory nursing students held workshops for a total of 175 Gateway clients, on topics ranging from diabetes and stroke prevention to self-esteem building and winter preparedness.
     It's not just a teaching experience for nursing students or a learning opportunity for clients. "The education goes both ways," says Donohue. Workshop attendees are now making suggestions about topics for future presentations, including arthritis, hepatitis C, and AIDS. Students are returning to Emory from Gateway with new ideas about old preconceptions. "It appears the experience for many of the students is very transformative," she says. "It changes the way they see and understand people who are homeless."
     Take Jessica Gross. The former anthropology and theology student became an RN last year and is now a dual-degree MSN/MPH candidate at Emory. Even before her first visit to Gateway, Gross's work at the South Fulton Medical Center had exposed her to some of the problems leading to homelessness. "In the emergency department, I have encountered patients with mental illness, a dwindling social network, and few resources," she says. "Where will they go when they are discharged? Suddenly, the path to homelessness seems inevitable."
     But already, through her time at Gateway, Gross knows she can make a difference on that path. That became clear after she and her classmates gave a presentation on tuberculosis at Gateway and were met with numerous requests from residents over the following weeks for screening tests for the disease.
 
     
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  Momentum Building

The health presentations are continuing this semester, and momentum is building, especially around Emory's efforts to provide holistic care to patients. A good example is Emory's faculty practice at Gateway's health recovery unit, which serves more than 20 patients who've recently been released from the hospital. Some have broken bones after having been hit by cars; others, like Johnny Hogue, just had surgery. "It's really a place to rest and recover, to get food, clothing, and shelter," says Donohue. "They're pretty much taking care of themselves physically, so we're really working more with mind and spirit. We give clients the opportunity to talk about their faith, to ask how they would use it to become healthier."
     That concept—of healing emotional, spiritual, and physical pain—follows the parish nursing model popularized in the 1980s. At Gateway, the need for that overall perspective emphasizing total wellness is strong. "Life on the street is very stressful," Donohue says. "The loneliness and isolation are just tremendous. Many have mental health issues; lots are bipolar. Stress is a huge deal. We want to give them a safe environment to reveal what is really going on with them."
     Because Donohue's focus is on more than the physical symptoms that Gateway clients describe, she and other faculty have been able to provide support and resources to those hoping to reconnect with family, those still struggling with addictions, and those depressed enough to consider suicide.
     For many clients, reconnecting with their faith is the key to making positive changes. "Many of the clients at Gateway are rooted in a faith tradition," says Donohue. "So we just ask the question, ‘How can you use your faith to help you grow toward a healthier life?' ''
     That integration of faith and health also comes through in other aspects of the collaboration. Many nursing student groups start their presentations with a short interdenominational prayer or a meditation, which helps center both those providing the information and those receiving it.
     To build more community, nursing students have also started having lunch with clients after their presentations. "This idea of sharing a meal brings down walls and eliminates barriers," Donohue says. "A lot of the clients need attention and time and listening. This affords that opportunity."
     As a result, clients have opened up to the nursing students and faculty about their lives and struggles. That sharing is unusual for the homeless, many of whom have learned in hard ways that trust isn't always rewarded. "They're ashamed of their situation and have a hard time with outsiders," says Gateway's Ford. "Outsiders are usually a threat when you're in a bad situation. But these guys don't see Emory as a threat."
     Oftentimes, what clients have to say is eye-opening to students. "Is there an expansive gulf between the average American and the man on the street? Most would probably say yes," says student Jessica Gross. "But the more time I have spent with the homeless, I have encountered them less as homeless and more as people. We share hopes, dreams, disappointments, struggles, stresses, difficulties, successes, failures, relationships, families—the human experience."
     For Gross, that lesson reaffirmed her vocation to work with marginalized populations. For others, their realizations at Gateway lead to reassessments of their own nursing practices. Donohue tells the story of one student who came to Gateway after being employed in a local hospital's emergency department. "It was the first time he saw a homeless person as a person, as someone with a story. He's more compassionate now. He still can't let them stay in the ER, but he'll give them a six-pack of Gatorade and a sandwich in a bag as he asks them to leave."
 
     
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  Under Expansion

With more than two years under her belt at Gateway, Donohue is now looking to expand the partnership, thanks to a new three-year grant from the federal Health Resources and Services Administration's Division of Nursing.
     To start off, the nursing school is sponsoring a new exercise program for women who live at Gateway, emphasizing stress relief, stretching, and meditation. Faculty members also are training Gateway staff about how to handle medical and hygiene issues and are planning regular blood-pressure screenings for clients.
     Emory's nursing school also has just opened a resource center at Gateway, which stems directly from Donohue's early experience at the center. "Staff kept coming up and asking, ‘Where can he go for a toothache?' ‘Where can she get glasses?' I started seeing there are so many resources already in this community, and yet people didn't know how to access these services. They were hard for me to find, so how could a homeless person in Atlanta figure them out? That's when it came to me." Now, one day each week, new project faculty member Jordan Bell Simcox, 05N, 06MN, and graduate student Mujidat Ladipo, 08MN, help clients gain access to health care-related services and products ranging from eyeglasses and HIV tests to gynecologic exams.
 
     
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      A Successful Collaboration

To Assistant Professor Ann Connor, who has been part of Emory's faculty practice at Gateway, the success of the collaboration is already obvious. "Part of being a nurse is being with lots of different people. What's wonderful is that the project has allowed more students to be involved with a vulnerable population," she says. "It's a gift for all of us." Connor knows that whether or not students' primary nursing work is with marginalized populations, this experience will affect their entire nursing outlook.
     The work also continues to affect Gateway clients, says Donohue. "We're gaining their trust and credibility as health care providers," she says. "Success for me is just being there. It's the opportunity to care for someone and help them see that someone cares—which then begins to change them. Many have never experienced that."
That's a sentiment Ford echoes. "The clients care about the people from Emory. They've learned to trust them on medical issues and to bring them their health information. They get good referrals. Emory is showing us nothing but good things."
 
     
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      There are so many masks I have to wear to survive," says Richard McWilliams. "We're so isolated. If you be too nice, they take it for a weakness. If you smile too much they take it for a weakness. So you always have to be prepared."
     That's just one insight about homelessness that students hear before stepping in the door of Gateway. McWilliams is one of two homeless men featured in the orientation video that helps Emory nursing students know what to expect when they walk into Gateway.
     The 19-minute film was produced by teenager Egan Marie Connor Short and features her mother, Assistant Professor Ann Connor, on her way to Gateway. The production includes debriefings on the causes of homelessness and the medical issues that go along with being homeless. But to start, Connor articulates the underlying tenet of the nursing school's involvement with Gateway: "There's always room to grow with more encounters and understanding."
     Watch the video online here.
 
     
 
         
         
     
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