COVID-19 Archives

COVID-19

Advanced practice nursing alumna strives to eliminate health care disparities in rural Oklahoma

March 18, 2021

Molly Hannagan (BSN ’98, DNP ’19) was among the first cohort to graduate from The University of Tulsa’s doctor of nursing practice (DNP) program, which provides advanced practice nursing students with the opportunity to expand their education through extensive hands-on and clinical experiences. Completing the program’s family nurse practitioner (FNP) stream, Hannagan gained the knowledge and skills required to provide primary care to people of all ages in a wide array of settings.

blonde woman wearing a white face mask and a yellow protective hospital gown — First day of treating and testing for COVID-19 (March 20, 2020)

Shortly after graduation, Hannagan was hired by Morton Comprehensive Health Services in Tulsa. After working there for a few months, Morton relocated Hannagan to its clinic in Nowata, Oklahoma, where she now serves as that facility’s primary care nurse practitioner. The clinic delivers a variety of services, such as acute sickness visits, chronic health condition management, physical exams and women’s health care. Hannagan herself cares primarily for all ages birth to death; currently, her oldest patient is 98 years old.

“Molly has always been in the top of her class and has a desire to improve patient outcomes” said FNP Director Sheryl Stansifer. “She is knowledgeable, dependable and genuinely cares for her patients. She is a perfect fit for the Nowata clinic.”

Serving a rural community

Nowata is a rural community in the northeastern part of the state, with a population of approximately 3,000. A significant portion of Nowata’s residents lives below the poverty line, making it difficult for everyone to have equal access to health care. Hannagan’s clinic works to eliminate that disparity.

Morton Comprehensive Health Services is a Federal Qualified Health Center (FHQC). As an FHQC, its clinics provide patients with care no matter their financial situation. “We treat both patients who have insurance and those who do not, and we provide services that are income based on a sliding scale,” Hannagan explained. “Our clinic has lots of available resources and grants that ensure patients get the treatment, medication and services they need to get well and stay well.” Hannagan credits her time in TU’s DNP program with opening her eyes to health care policies and legislation and how they impact different communities.

Well-prepared to care

From a medical perspective, Hannagan also noted that TU’s FNP stream “directly prepared me to provide primary care at my clinic. I use my degree every day to diagnose and treat my patients.” Within the program, Hannagan gained experience in a variety of different medical fields, as well as pathophysiology, disease process and pharmacology. She recalls numerous hours spent learning how to perform thorough assessments and physical examinations in order to establish a diagnosis and treatment plan. Hannagan also benefited from access to state-of-the-art labs and clinical situations that gave her hands-on learning experiences.

two women wearing face masks, face shields and blue hospital gowns — Testing for COVID-19

“I was placed with great precetpors at each of my clinical sites,” Hannagan said. “It was at the Henryetta ER where I was first exposed to rural health. During my time there, I worked with Dr. Carl Glidden learning to suture, evaluate diagnostic imaging and perform minor procedures.”

She went on to gain experience in rural health at the Xavier clinic, which serves a largely non-insured Hispanic population. “I learned how to manage diabetes, and I even learned how to perform a head-to-toe assessment in Spanish there,” she recalled.

Hannagan also credits the DNP program with developing her skills beyond medicine. In particular, she notes that she was able to cultivate valuable leadership and communication skills. These skills allow her to work effectively with team members from multiple disciplines and backgrounds, both inside and outside the clinic.

Continuing to learn and grow

Working at the Nowata clinic affords this lifelong learner daily opportunities to increase her knowledge and skills. With the chaos of the COVID-19 pandemic, for instance, Hannagan has had to learn how to be adaptable to ever-changing workplace conditions. “My company has provided sound policies and procedures based on the current information, despite how often it changed,” she remarked. “I have access to all the personal protective equipment I need, as well as to all the testing supplies and medication my patients need. I am grateful for that support, as well as for the fact I have not contracted COVID-19.”

two women and one man wearing protective face masks — Hannagan with her oldest patient and another nurse

Hannagan advocates that BSN-prepared nurses with an interest in advancing their professional practice should consider TU’s FNP pathway: “It will be hard, but so worth it. Don’t let anything stop you. Being a family nurse practitioner in a rural setting and building relationships with my patients and improving their health care outcomes is proving to be the most rewarding experience of my life.”

TU’s doctor of nursing practice (DNP) program gives students the ability to make real and lasting change in their communities. Learn more about the DNP program’s four pathways and how they can empower you to deliver superior care for your patients.

Speech-language pathologists at the frontlines of COVID-19 patient care

March 12, 2021

“I am so grateful that I have gotten to put my professional knowledge to use in order to help people during these unprecedented pandemic times,” said Natalie Crise (BS ’17, MS ’19). A graduate of The University of Tulsa’s bachelor’s and master’s programs in speech-language pathology, Crise today works for Tulsa’s Saint Francis Health System.

woman in black top and pants standing in front of a sign that reads Saint Francis Health System — Natalie Crise

Many people likely have an idea that speech-language pathologists (SLPs) primarily work to help children overcome lisps and stutters or elderly people deal with cognitive deficits impacting their ability to communicate and complete daily tasks/activities. While many perform such roles, the COVID-19 pandemic has revealed a markedly different side of the profession, particularly for SLPs, such as Crise, who work in hospitals. Indeed, for the past 20 years, TU SLP alumna Teresa Bierig (BS ’92, MS ’94) has focused her career on the hospital setting, both in patient care and management roles. Today, she is deploying her specialized skills and knowledge to help COVID-19 patients at Tulsa’s Hillcrest Medical Center.

“SLPs working in hospitals during the COVID-19 pandemic have been on the frontlines of patient care,” Bierig noted. “We have all seen the devastation this virus can have on people, both patients and their loved ones.”

Swallowing

One of the main reason SLPs are an essential part of so many COVID-19 patients’ interdisciplinary care teams – including dietitians, respiratory therapists, nurses, physical and occupational therapists – is because of the swallowing deficits caused from being on a ventilator. These life-support machines mechanically pump oxygen into a critically ill person via a tube inserted down the throat and into the airway/lungs.

woman in hospital scrubs wearing a face mask respirator — Teresa Bierig

The throat, however, contains many important swallowing structures and it is easy to damage them when inserting and extracting a ventilator tube. As Bierig observed, “the breathing tube is a good thing in that it helps the patient to breathe; however, it is also a foreign object and can irritate the swallow mechanism’s tissues and muscles.” Added to such damage is the fact that a patient is physically unable to swallow while the ventilator tube is in place, thus progressively weakening the swallow mechanism and its associated muscles through inactivity.

Crise explained this complex situation and the dangers it poses: “The main structures and muscles work together to close of the airway and propel food and liquids down into the esophagus. But when the swallow structures are damaged or weakened, they can’t do their job to protect the airway. In that case, when a patient swallows, food and liquids travel down into the lungs. Over time, this can lead to aspiration pneumonia and worsen the respiratory issues that many COVID-19 patients are already facing.” Aspiration pneumonia also usually prolongs a person’s hospital stay.

Once a patient comes off a ventilator, the first thing a SLP does is assess any weakness or damage that may be present. The next step is to make recommendations to help the individual eat and drink safely, including modifying their diet, as well as teach them how to exercise and, thereby, strengthen their swallow mechanisms. For critically ill COVID-19 patients, noted Bierig, SLPs also focus on respiratory muscle strength-training. “This helps them to produce a cough that is sufficiently strong to cough out food, liquid and anything else that might have slipped into the airway.”

Speaking

Known in health care as “dysphagia,” difficulties swallowing are only one of the ventilator-related ailments with which SLPs help COVID-19 patients. Ventilator tubes can also cause trauma to a person’s delicate vocal cords. When a person is already physically weakened and perhaps even temporarily cognitively diminished from battling the coronavirus, a damaged larynx makes speaking all the more difficult.

In addition, patients with severe cases of COVID-19 will often require insertion of a tracheostomy tube, which is inserted through a hole made in the front of the neck into the windpipe (trachea), in order to breathe. Patients commonly require tracheostomy tubes when they have been on a ventilator a long time and yet still cannot breathe on their own.

“When a patient has a tracheostomy tube in place,” explained Crise, “air from their lungs goes directly in and out from their neck, rather than passing through their vocal cords. Essentially, therefore, a person in that situation loses their voice.” Fortunately, there is a prosthetic device that can be fastened to the end of a tracheostomy tube that, by directing air back through the vocal cords, “gives them their voice back.”

Both Crise and Bierig have deployed these devices with numerous COVID-19 patients. One patient Crise recalled who found himself in this situation had contracted the virus in late December, was immediately placed on a ventilator and eventually switched to a tracheostomy tube. During all that time, he had been unable to utter a word to his loved ones. Crise saw him around the end of February, at which time she placed a speaking device on the end of his tube. “For the first time in two months he was able to talk,” Crise said. “We Facetimed all of his family members and they were so happy to finally hear his voice after such a long time. I went home after work that day feeling on top of the world.”

TU’s Department of Communication Sciences and Disorders offers undergraduate and master’s level education for prospective speech-language pathologists. Learn more about how to gain the knowledge and skills required to enter this in-demand health care profession.

Don’t pump up the volume: TU audiology expert offers insight on healthy hearing during the pandemic and beyond

May 20, 2020

The COVID-19 crisis has spawned new health-focused behaviors across the country: repeated hand-washing, standing 6 feet apart at the post office, waving at grandmothers from outside their retirement residences, keeping a cloth mask in the glove compartment in readiness for grocery expeditions. These sanitary practices are all meant to curtail the spread of a potentially deadly virus. But what about other aspects of our health during this pandemic era?

Julie Hyland, AuD, is a clinical associate professor in The University of Tulsa’s Department of Communication Sciences & Disorders and an audiologist with the Mary K. Chapman Speech & Hearing Clinic. One of Hyland’s concerns during the pandemic is that many people are unaware of the risk of noise-induced hearing loss (NIHL).

“The only 100% preventable cause of permanent, sensorineural hearing loss is NIHL,” Hyland explained. During the current health crisis, she noted, many people are spending more hours than usual using portable media devices with headphones and earbuds for remote work and schooling purposes. That is on top of using them for entertainment.

According to Hyland, this new normal presents some serious risks: “In a family comprising, for example, parents working from home and children learning at home, there’s going to be a lot of noise. The natural tendency in such a situation would be for everyone to pump up the volume on their individual devices in order to hear over all the background noise. But that increased duration of exposure to higher volumes amplifies the risk of acquiring NIHL.”

Noise intensity + duration of exposure

This pandemic-intensified risk is set within the already high rates of NIHL in the United States, Hyland pointed out. A 2011-12 study from the Centers for Disease Control and Prevention found that at least 10 million adults in the United States under age 70 (6% of the population), and perhaps as many as 40 million (24%), indicated in their hearing tests the possibility of hearing loss in one or both ears from exposure to loud noise. Researchers have also estimated that as many as 17% of teens are similarly affected.

The two primary factors to consider when it comes to hearing conservation and prevention of NIHL are the intensity of noise – measured in decibels (dB) – and the duration of exposure to it.

The average conversational speech is around 60 to 70 dB. Noise levels of 85 dB or higher – such as from a leaf blower, chainsaw, gunshot, ambulance siren – have the potential to damage one’s auditory system if the duration of exposure is sufficient. Even a hair dryer has the potential to hurt one’s hearing. A typical hair dryer runs at about 91 dB, which does not become a problem if exposure is under two hours. “You are unlikely to run your hair dryer for two hours at home,” noted Hyland. “But a stylist working in a salon might be exposed to hair dryers for much longer than that over the course of a typical shift.”

Protect your hearing

For her patients and everyone else, Hyland offers the following advice to guard against hearing loss:

Keep the volume of your devices – and your children’s – set no higher than about 60% of the maximum.
Take breaks. For example, it’s okay to listen to music while working at your computer, but don’t do so for longer than about 30 minutes. Then, turn the music off and get up to stretch for 10 minutes.
Use hearing protection, such as earplugs and earmuffs, when engaging in loud activities, such as mowing the lawn, attending concerts and woodworking.
See an audiologist for a full hearing evaluation if you experience signs of NIHL. Such signs include increased difficulty understanding speech in noisy listening conditions or tinnitus, which is a ringing, buzzing or roaring sound in the ears or head.

For parents, Hyland has some additional specific counsel: “You might think that if you can hear the sound coming from your child’s earbuds, then the volume is set too high. But that’s actually more indicative of how well the device is sealing off the ear canal. A really tight seal might mean you can’t hear anything, but the intensity levels might well be damaging your child’s hearing.”

Audiology is an important element in training to be a speech-language pathologist at TU. Graduate students in TU’s speech-language pathology program learn best practices for screening their clients’ hearing. Undergraduate students in Hyland’s audiology courses learn methods of evaluating and treating hearing loss as well as how hearing loss impacts communication and quality of life. Consider joining this dynamic and growing field by applying today.

TU nursing students address community health in the midst of the pandemic

May 4, 2020

With COVID-19 raging and all in-person learning replaced with virtual instruction, faculty in The University of Tulsa’s undergraduate nursing program had to quickly figure out a way to replace clinical rotations while still ensuring their students received a high-quality, relevant education. The ingenious result was to devise a four-week model for juniors in the bachelor of science in nursing (BSN) program examining client education in the context of a pandemic.

“This solution made additional sense,” noted Chapman Clinical Assistant Professor of Nursing Angela Martindale, “given that this is the semester when those students focus on community health.” Martindale taught the course alongside her colleagues Lee Anne Nichols and Cassandra Barrow, both of whom also had a hand in shaping the new direction.

“From social distancing to sickness, COVID-19 has created a spark and lit sequential fires of change within me,” said Adonijah Young, one of the students in the course. “Being given the opportunity to create educational tools to instill knowledge in the community was an amazing experience.”

Young’s sentiments are echoed by fellow student Emily Thomas, who said the community rotation enabled her “to put my feet in other people’s shoes and think critically about what they are feeling and thinking during this time of uncertainty. I am confident the work I did and the skills I developed will benefit me in my future career as a nurse.”

COVID-19 and social distancing

The first week introduced students to the origin and context of the novel coronavirus that causes COVID-19. Students reviewed a simulation PowerPoint deck and completed a World Health Organization module on the topic. “Our students wrapped up this first stage by taking a short quiz and earning a certificate of completion,” explained Nichols.

Week 2 involved four simulations covering the COVID-19 pandemic and explored the impact of social distancing at local, state, national and global levels. The epidemiological curve was examined at each of those levels, as well as the pandemic risk mitigation plan for both Oklahoma and the United States to flatten the curve. “A main element of our exercises this week was to explore the nursing perspective at each level,” said Barrow. “In support of that goal, our students’ clinical activity was to identify between 5 and 10 ineffective and between 5 and 10 adaptive responses to social distancing right here in Tulsa.” The students then worked in small groups to create PPT decks that shared their findings and presented a nursing diagnosis.

Nursing, pandemic ethics and public education

“During Week 3, students worked in pairs or groups of three to develop a white paper, suitable for the public, on nursing and pandemic ethics,” Martindale noted. These drew on assigned readings and discussions dealing with topics such as the role of nurses who lack personal protective equipment when taking care of patients who have COVID-19. The course wrapped up with a case study/simulation exercise. For this, students wrote individual care plans dealing with an aggregate of patients battling COVID-19. “Having community health online was a very good learning experience for me because I was able to research topics concerning our community on my own and find information on how we can help,” said student Averee Dubach.

Other assignments included developing educational tools for homeless people, families with children at home, the elderly and patients in clinics. “By the time the rotation was over,” remarked Nichols, “we had over 84 brochures developed to teach aggregates of clients affected by the pandemic.” Many of these brochures will be shared with community partners as our society continues to fight the COVID-19 pandemic.

Impacts: From the personal to the global

The final assignment involved having each student write a reflective paper discussing how the pandemic had affected health at the local, state, national and global levels. They were also tasked with writing about how social distancing had impacted them personally. As Carol Coffman put it, “Although finishing my junior year of nursing school away from people was not ideal, it was necessary and allowed me to reflect on my role and take responsibility as a future nurse.”

Student Emma Rutter summed up the profound impact of the reimagined clinical rotation on her development as a caring, effective health care professional: “As nurses, we must remember that health is not singular. If our patients are ailing, our community is ailing. We learned how to advocate for an entire aggregate and plan how to take steps to affect the masses. The lesson I am most thankful for in this community rotation is: Your community needs you, and you most definitely need your community. There is always hope when there are those who continue to try.”

Students Emma Rutter, Trenton Hazelton and Carol Coffman wearing blue scrubs — BSN juniors Emma Rutter, Trenton Hazelton and Carol Coffman in the days before the COVID-19 pandemic

If you would like to inquire about using some of the BSN students’ educational resources at your organization, please contact Wendy Palmer at the TU School of Nursing (wendy-palmer@utulsa.edu).

TU’s speech-language pathology faculty and students deliver therapy at a distance

April 16, 2020

Teletherapy – or telemedicine – has been around for some time. But the recent arrival of COVID-19 has led to a surge of activity for health care professionals from many disciplines. Faculty and students in The University of Tulsa’s Department of Communication Sciences & Disorders are among those who have embraced teletherapy in order to serve patients during this crisis.

Communication Sciences and Disorders has the largest number of patients in Oklahoma who attend an on-campus clinic. Indeed, the department has more patients than most graduate program clinics anywhere in the state.

Speech-language pathology master's student Gabrielle Cozart sitting at a table with a laptop computer — Gabrielle Cozart, speech-language pathology master’s student

“Over the past few years, our faculty have seen a few patients via teletherapy,” said Suzanne Stanton, the coordinator of TU’s Mary K. Chapman Speech and Hearing Clinic and the Chapman Clinical Assistant Professor of Speech-Language Pathology. “One such individual was a young adult who lived in rural Oklahoma and needed therapy to use her eye-gaze communication system. There was no one in her area with that specific expertise, so teletherapy sessions with one of our faculty members was the solution.”

In 2019, Professor Kris Foyil initiated a contract with Connects Academy to allow the department’s graduate students to work with practicing teletherapists in the community. Since then, each semester two students have been able to work with an experienced licensed teletherapist in her practice.

Rising to the challenge

With the COVD-19 crisis, Communication Sciences & Disorders students were forced to abruptly discontinue their externships and onsite clinical experiences. The Council on Academic Accreditation, however, sent out a notice to accredited programs stating that the standards for certification and completion of clinical hours would not change. As a result, the department had to find new ways for their students to satisfy those requirements in order to graduate on time in May.

Speech-language pathology master's student Marisa Nelson at a table with a laptop computer and paper documents — Marisa Nelson, speech-language pathology master’s student

“We are meeting the needs of our students in several ways,” Stanton noted. “And teletherapy has been a major asset to accomplish that goal.”

During the week of March 23-25, faculty began teletherapy evaluations to assist graduate students who had been pulled from hospital experiences. This included having members of TU’s Tulsa Aphasia Group participate in online aphasia evaluations with students using Zoom technology and following both state and federal guidelines for teletherapy. Stanton coordinated these evaluations, which allowed patients to get the services they needed and the department’s students to continue interacting with individuals.

“It was a quick turnaround to organize,” remarked Stanton, “but rewarding in so many ways. For instance, the patients we helped were isolated, and this taught them how to use new technology to foster social interactions in other situations and settings. One gentleman, for example, was able to use Zoom to talk with his grandson and son in Colorado.”

Simulations

Simulations are the second way Communication Sciences & Disorders is meeting its students’ needs through digital technology. The benefit of such simulation is it allows no-risk practice in aspects of care that previously could only be experienced with patients in person.

Sarah Launchbaugh, a clinical assistant professor of speech-language pathology, has worked with other clinical faculty to organize simulated clinical experiences through Simucase. “By using Simucase’s digital learning platform,” Stanton observed, “our students are able to continue their clinical practica, even during the pandemic in a time of uncertainty in the world around us. It also gives them exposure to patient populations that are at times unavailable in our speech clinic due to low incidence of the disorders.”

Future plans

Spurred on by the COVID-19 emergency, Communication Sciences & Disorders faculty are working with students to offer all clinic services via teletherapy soon. According to Stanton, “we are currently providing online resources for patients and their families, and we are reaching out to determine which patients have the ability to participate in teletherapy.”

Are you interested in a career as a speech-language pathologist? TU’s Communications Sciences & Disorders department has the pathways for you!