03/20/17

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Michelle Garrison and her daughter Ashley Caldwell have always led an upward bound trajectory in their field of labor and delivery.

by James Coburn
Staff Writer

It’s always interesting when patients learn that Michelle Garrison and Ashley Caldwell, both registered nurses, are mother and daughter.
Garrison and Caldwell have common paths in nursing. Both are labor and delivery nurses working at INTEGRIS Health Edmond. Both are registered nurses in school full-time.
“It doesn’t always fall that we get the same shift, but when we do it’s like a little treat that we get to work together,” Caldwell said.
Garrison is a full-time scholar in the Doctor of Nursing Practice program at the University of Oklahoma. And Caldwell is a certified nurse midwife student at Frontier University in Kentucky. Garrison is certified in inpatient obstetrics and serves as a faculty member at the OU Health Sciences Center, Fran and Earl Ziegler College of Nursing.
In addition to Caldwell working at INTEGRIS Health Edmond and going to school full-time, she is also an adjunct clinical instructor at Oklahoma City Community College. She does clinicals for their third semester, Caldwell said.
“It’s especially touching to me because the nurse who took care of me when this daughter was born at Stanford Hospital, was the inspiration for me becoming a labor and delivery nurse,” Garrison said.
“Now we are 30 years later, both doing what we love,” she added.
Garrison said she is amazed at her daughter’s knowledge of obstetrics and her love and devotion for becoming a midwife as an advocate for labor patients to have the experience they desire.
Caldwell was 8-10 years old when her mom was in nursing school.
“She always told me, ‘Something that I would like to do, maybe, is be a nurse midwife,’” Caldwell said. “I would say, ‘What is that?’”
Garrison would explain a midwife is a nurse who can deliver babies. As Caldwell grew up and went to nursing school, she attended her first birth and was hooked immediately, she said. When she decided to go back to school to earn her master’s degree Caldwell opted to become a nurse midwife.
“She always says, ‘If I was younger, I’d go back and do it,’” Caldwell said.
A certified nurse midwife is distinct from Caldwell’s current role as a labor and delivery nurse. As an advanced practice nurse, a midwife offers primary care for women from the onset of puberty to menopause just as a women’s health nurse practitioner does.
“I can do clinic, prescribe birth control, do family planning and annual exams,” Caldwell said. “Midwifes have the added bonus that they have a specialty in obstetrics.”
A nurse midwife offers prenatal care, intrapartum care and delivery low-risk pregnancies as well as work in an inpatient labor and delivery setting, said Caldwell, who graduated from nursing school at OSU/OKC before earning her Bachelor of Science in Nursing from Southwestern Oklahoma State University.
She has been with INTEGRIS since 2010 and at the Women’s Center in Edmond for nearly two years.
“I just love it here. I like that we’re a big family here,” Caldwell said. “We’re kind of a smaller unit, but we’re growing. I’ve worked for these women for a long time and I love it here.”
Garrison was first to work at INTEGRIS Health Edmond. Caldwell was working at INTEGRIS Southwest and transferred to Edmond.
Garrison graduated from Rochester Community College in Minnesota. She then earned her Bachelor of Science degree at Southwestern Oklahoma State in Weatherford and earned her Master of Science degree at OU.
As a full-time scholar in the Doctor of Nursing Practice program at OU, Garrison can choose to work in administration, education and the clinical setting.
“The difference between a DNP and a Ph.D. is a Ph.D. is research based. The DNP is clinical based, and I’m a more clinical based person,” Garrison said.
She is just finishing her first year and everything she has learned at OU is pertinent to working as a leader on the nursing floor, Garrison said.
“So INTEGRIS, when I came to work here, I found the group of nurses that work here are so experienced and talented,” Garrison continued. “We all work well together. Some of them I know from other places. What I like about it here is everybody supports everybody.”
If an issue comes up with fetal heart rate, three nurses respond immediately.
“It’s very much like Ashley said, a family,” she said.
Garrison said she is always excited when she knows her daughter will be working her same shift. But every time they work together they are busy.
“And we really never get to talk,” Garrison said. “It’s really like we’re in passing.”
Caldwell said they always have a fun story to tell their patients about working as mother and daughter.

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Amber Chan enjoys caring for people, young and old in her career. Today she is a registered nurse at Golden Age Nursing Center in Guthrie.

story and photo by James Coburn, Staff Writer

Amber Chan likes the circle of life so much that the registered nurse went from working in pediatric care to geriatric care at Golden Age Nursing Center, located in Guthrie
Chan spent five years as a pediatric nurse before transitioning to a new opportunity for learning at Golden Age about a year ago.
“I got to see a lot of the beginning of life because I’ve always been interested in the other end of the spectrum,” Chan said. “And then I had a previous coworker who recommended working here. They said this was a really good place to work, so I decided to try here.”
She earned her Bachelor of Science degree in Nursing at OU/OKC six years ago. During her freshman year of college, she knew she wanted to accomplish a medical career although she was uncertain of the field.
“And then I decided with nursing I can still take care of people and have a family,” she said. “It’s a better balance than doing other options that there are in medicine.”
Golden Age allows her to be part of an extended family, she said, not only with her coworkers but with the residents.
“We’re basically part of their family now. I like being able to have that longer connection with them, getting to know them,” she said. “You get that bond that you don’t necessarily get in a hospital because you’re with them so much more.”
The residents have a love of life that does not go unnoticed for Chan. They care about the other residents as well as the Golden Age staff. They can tell when a nurse needs to be uplifted during a challenging day.
“They care about how you’re doing,” she said.
Families of the residents are also good to know, Chan continued. The majority of the residents have awesome families who frequently check-up on their loved one’s welfare.
“They care about staff, too,” Chan continued. “They make you feel part of a family – a very large family. So that’s one of my favorite parts.”
Chan often reflects on the friends she has made among the residents. One was a teacher.
“My mom is a teacher,” Chan said. “She just reminded me so much of my mom and she would do some of the wildest things out there, but she was also so sweet and she told me that she loved me.”
“I like thinking back on her because it makes me laugh. She had a lot of soul. So I like thinking about her because I can look forward to that with my mom when she is in her 90s.”
When thinking about the Golden Age staff, Chan is impressed by how much they care about the community of elders. Everybody does an amazing job wherever they are working. Her admiration extends to housekeeping, cooking and the CNAs.
“Everybody cares about the job that they are doing,” Chan said. “And then nursing staff wise; you always have somebody to help. They care and they want these people to be taken care of well. So they’re willing to do whatever it is that needs to be done to make sure everyone is taken care of well.”
The CNA staff is the front line with the residents, she said. They can tell if something is not right with a resident and inform the nurses.
“Say that issue doesn’t get addressed right away, they’ll make sure if you get busy that you look. They are persistent and not scared to say what is going on,” Chan said.
Her life as a nurse is enriched by knowing she is a part of the residents’ lives, Chan said. Each day, a little task such as bringing someone ice cream will make their day.
“You know that you’re making a difference by being able to be here and help them,” she said.
Caring is the No. 1 quality of a long-term care nurse, Chan continued.
“You have to care about people because you can be very busy. So you have to have good time management.” Chan said. “So if you don’t care to want to work hard, you need to want to be here and part of their lives.”
Another reason why Golden Age appeals to her lifestyle is that if a child is sick she can be there with him.
“I have a 5-year-old son and he had the flu a month ago,” she said. “My husband stays at home with him. He’s a stay-at-home dad. So I just want to be there if he’s sick, and it was not problem for me to be there.”

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Lisa Kennedy, LPN, ADON and staff educator at Grace Living Center Wilshire says her work gives her the opportunity to have plenty of grandmas and grandpas.

CAREERS IN NURSING
PERFORMANCE WITH COMPASSION: ADON LIFTS HER PROFESSION

by James Coburn – Writer/Photographer

The nursing staff at Grace Living Center Wilshire in Oklahoma City is admirable, said Lisa Kennedy, LPN, ADON and staff educator.
“We have a pretty good staff and they seem to be caring. They try to individualize each resident for their needs and try to address them in that manner. They really care,” said Kennedy, who has worked for Grace Living Center for nearly 14 years.
“The thing I like most about this facility is it’s a small facility. And you get to spend time with the residents and get to know them,” she said. “You get to hear their stories from their past and just feel good about the relationships with the residents and the staff.”
She commends the residents for doing their personal best to be active, Kennedy said. Residents also let the staff know when other residents are not feeling well.
“They come to us and let us know when somebody wants us to do something,” she continued. “I like that they’re happy. I think that’s very important.”
Any career can bring its rewards along with challenges and stress. But there are also memories nurses carry within them, reminding them of their purpose. And Kennedy loves all of the residents for who they are.
“I don’t think one resident sticks out. I just like hearing about their past and things that they have been through,” she explained.
One lady who live there had been a school teacher. She continued living at Grace continuing to teach other residents.
“She would be the first one to try to explain something. I guess I like to say they just never lose who they are. So I like that,” Kennedy said.
Kennedy has learned a lot from teachers in her life. After graduating from Douglas High School, Kennedy attended Langston University and later graduated from Platt College to earn her nursing credentials. She began as a CNA when she was in high school. She worked at Terrace Gardens and Grace Living Center NE 21st Street in Oklahoma City.
“Initially I had cared for some family members before. Not completely, but I took turns with my family members to care,” she said. “I think that’s how it all started.”
She fell in love with working with older residents as a CNA. Being a CNA at the time gave her confidence to not be afraid of learning. She was hands-on with the residents instead of simply learning from a book and applying the necessary skills, Kennedy said.
“So a lot of things I had seen as a CNA, I was able to apply that in my nursing skills,” Kennedy said.
She has never forgotten that a CNA performs with the hardest job in a nursing home, she said. Kennedy explained that nurses at different facilities often set their admiration based on titles.
“I think a lot of places forget about how hard the CNAs work to make sure the residents have what they need,” she said. “Just the many tasks they perform in a day is a lot.”
As an educator, Kennedy lets them know of their importance. She will try to encourage and uplift them for the work they do.
“I just try to have something positive to say. Seeing that I’ve been a CNA before, I can relate to some of the struggles they go through,” Kennedy said.
She also encourages them and anyone who is compassionate to consider a nursing career. But first they need to bring with them qualities of patience and caring.
“A lot of people have gone into the nursing field, I think just because of the higher pay wage,” she said.
Those people don’t seem to have made it very far into their fields of nursing, Kennedy said.
“It’s definitely a job that you have to be willing to have some compassion,” said Kennedy, who is also loyal to her residents and the community she serves.
“I think what motivates me the most is I could very well be in a situation where I have to come to a long-term care facility,” she said. “You know I would want to be treated right. I would want someone to care about me and to look out for my best interests.”
She also adheres to Grace Living Centers standards of excellence, she said. Its values help the nursing staff to serve the residents.
“It helps you to remember why we’re here,” Kennedy said.
When away from work Kennedy said life is the same. When she is not caring for a resident, she is caring for her children and family.
“Also, too, I think why I love long-term care is because it’s kind of like being at home,” she said.

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Oklahoma Medical Research Foundation scientist Chris Sansam, Ph.D.

The Oklahoma Medical Research Foundation has received a five-year, $1.7 million grant to look at how DNA replicates itself. The results could lead to new information about how cancer and birth defects develop.
The grant, awarded by the National Institute of General Medical Sciences, will allow OMRF researcher Chris Sansam, Ph.D., to better understand what goes wrong in cells during the development of cancer and birth defects by applying what is learned in a normal setting in the genes.
DNA replication is the process by which genes duplicate. Every human begins as one cell, but the body is comprised of billions, meaning countless cell divisions occur during a lifetime.
“Every time a cell divides, the entire genome has to be replicated accurately, but the mechanisms responsible for that are still largely unknown,” said Sansam. “If we can understand how things are supposed to operate under normal circumstances, then we can identify what happens when things go wrong.”
DNA replication occurs constantly in the body, said Sansam, starting from a single cell that contains all the genetic material inherited from each parent. As cells divide, a full complement of genetic material has to be copied and put into each new cell produced, so it is not surprising that things can go awry if mistakes occur in the process.
“If the genetic material isn’t copied accurately, that leads to cancer. If it happens during embryonic development, it causes birth defects,” said Sansam, who is an assistant member in OMRF’s Cell Cycle & Cancer Biology Research Program.
Sansam’s grant aims to understand exactly how this process functions by identifying the genes, molecules and mechanisms that are needed to correctly replicate our DNA.
To accomplish this, Sansam uses zebrafish, semi-transparent, aquatic creatures that grow to no more than an inch in length. The tiny fish, which are common in home aquariums, are especially good scientific subjects because they share 70 percent of humans’ genetic code.
“The zebrafish is an incredible model to study, because virtually all basic cellular processes are the same in fish as they are in humans,” said Sansam. “We can learn a lot about how things work in humans by first studying an accessible, low-cost organism like zebrafish.”
Sansam joined OMRF in 2010 from the Massachusetts Institute of Technology (MIT) in Cambridge, Mass.
“It is unusual for a young investigator to be successful in a first try at getting a grant of this magnitude funded,” said Gary Gorbsky, Ph.D., who heads the Cell Cycle & Cancer Biology Research Program at OMRF. “However, the research that Dr. Sansam proposed has so much novelty and importance that the grant review panel found it very exciting. We’re proud of the work that Dr. Sansam and his laboratory members are doing, and we anticipate many fantastic discoveries in the future.”
The grant, number 1R01 GM121703-01, is from the NIGMS, part of the National Institutes of Health.

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What is your nursing superpower? AllianceHealth Midwest Birth Center

For me, it’s teaching breastfeeding. That’s what I do. Chelsea Drake, RN

Probably humor. I laugh all the time. Shelly Green, RN

Leadership and supervision. That’s a nice way of saying bossy. Diana Stone-Edgar, RN

Being with patients, explaining things to them and making them feel at ease. Sherri Ausburn, RN

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Vicki L Mayfield, M.Ed., R.N., LMFT Marriage and Family Therapy Oklahoma City If you would like to send a question to Vicki, email us at news@okcnursingtimes.com

Q. I think one of my co-workers is bipolar. She can be so nice and easy to work with then, unexpectedly she is mean and hateful. Sometimes it feels like I am walking on eggshells, unsure what might set her off. She does not maintain friendships. People try to stay away from her. Do you think she needs medication?

A. Your co-worker might be bipolar or she might have a personality disorder or she might have both. Frequently, the diagnoses are used together.
First let me help you understand bipolar. Before the diagnosis can be made the individual must meet the following criteria for a manic episode(as listed in the Diagnostic and Statistical Manual of Mental Disorders, DSM)
1. A distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least one week.
2.During the period of mood disturbance three of the following symptoms have been present to a significant degree: *inflated self esteem or grandiosity *decreased need for sleep *more talkative than usual/speech is pressured. *excessive involvement in pleasurable activities that have a high potential for painful consequences (i.e., unrestrained shopping sprees, sexual indiscretions, gambling)
Now lets look at some diagnostic criteria for Borderline Personality Disorder.
* A pervasive pattern of instability of interpersonal relationships, self-image, and marked impulsivity beginning by early adulthood and present in at least five of the following:
* A pattern of unstable and intense interpersonal relationships characterized by “I love you/I hate you.”
*Identity disturbance markedly and persistently unstable self-image.
*Affective instability….raging is the most profound of the borderline symptoms. Lack of affective moderation, the “zero to 100” is frequently seen.
*Inappropriate, intense anger or difficulty controlling anger (i,e,.frequent displays of temper, constant anger, mean/hateful comments about others
So now you have something to think about. Yes bipolar disorder can be pharmaceutically treated and people who stay on their medications can function very well. There is no medication that changes borderline personality. Therapy is recommended, although many do not make the commitment for the long term treatment.
It can be difficult to work with someone who is manic but not as difficult as working with someone who is borderline. I hope this information is helpful.

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Kathryn Arrambide, M.D., F.A.C.P.
Kevin Tulipana, D.O.

 

Tulsa, Okla. – Cancer Treatment Centers of America® at Southwestern Regional Medical Center in Tulsa (CTCA) announces two recent physician changes – Kathryn Arrambide, M.D., F.A.C.P., has joined the hospital as a medical oncologist and hematologist and Kevin Tulipana, D.O., who served as a hospitalist in the special care unit, has been promoted to medical director of hospital medicine.
Dr. Arrambide has extensive experience in treating blood cancers and disorders, as well as lung, breast, cervical, uterine and advanced-staged cancers. In addition, she is board certified in medical oncology and hematology. Prior to joining CTCA®, Dr. Arrambide worked at a medical group in Quincy, Ill., where she was a partner and served as medical director of clinical research. Prior to that, she practiced at various clinics and hospitals in the Dallas area, where she grew up.
With a bachelor of science degree in clinical nutrition with an emphasis in nutrition in cancer patients from the University of Texas Health Science Center at Dallas, Dr. Arrambide received her doctor of medicine at the University of Texas Southwestern Medical Center and later completed her hematology/oncology fellowship there. She also served as chief fellow in hematology/medical oncology from 1994 to 1995.
Dr. Tulipana, who joined CTCA in January 2015, earned his bachelor’s degree in biology at Truman State University in Kirksville, Mo. He completed his doctor of osteopathy degree at Des Moines University College of Osteopathic Medicine & Surgery. He was a resident in Family Medicine at Mercy/Mayo Family Medical Center, serving as chief resident from 2002 to 2003.
Prior to joining CTCA, Dr. Tulipana provided family medical care at a large regional medical center in Missouri for seven years. He then served as hospitalist at a large health-care facility in Oklahoma. During his career, Dr. Tulipana has also held several administrative positions focused on quality improvement, innovation and other aspects of patient care.
“We are thrilled about Dr. Arrambide joining our team. Her background aligns strongly with the CTCA model of care, and she has a good grasp on the whole-person needs of cancer patients,” said Dr. Daniel Nader, chief of staff at the Tulsa hospital. “We are also excited about Dr. Tulipana’s promotion. He understands the importance of compassionate care, while also being committed to quality improvement and innovation.”

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Poisoning is a common cause of childhood injury, especially among children 6 years old and younger. A poisoning can be caused by any substance that causes a toxic effect or bodily harm, such as medicines, liquid nicotine, or household products.
As part of National Poison Prevention Week 2017, March 19-25, the Oklahoma State Department of Health (OSDH) offers the following safety tips to prevent a poisoning.
* Store medicines, liquid nicotine, cleaning and laundry products (including detergent packets), paints/varnishes and pesticides in their original packaging in locked cabinets or containers, out of sight and reach of children.
* Safety latches that automatically lock when you close a cabinet door can help keep children away from dangerous products, but there is always a chance the device will fail. Never leave children alone with household products.
* Purchase and keep all medicines in containers with safety caps and keep out of reach of children. Discard unused medication. Note that safety caps are designed to be child resistant but are not fully childproof.
* Never refer to medicine as “candy” or another appealing name.
* Check the label each time you give a child medicine to ensure proper dosage. For liquid medicines, use the dosing device that came with the medicine. Never use a kitchen spoon.
* When taking medicines, do not put the next dose on the counter or table where children can reach them.
* If you use an e-cigarette, only buy liquid nicotine refills that use child resistant packaging, and keep refills locked up out of children’s reach.
* Put the Poison Control number, 1-800-222-1222, on or near every home telephone and cell phone for 24 hours a day, seven days a week access.
To learn more about how to prevent unintentional poisonings, contact the OSDH Injury Prevention Service at (405) 271-3430 or visit http://poison.health.ok.gov. For more information about the dangers of liquid nicotine, contact the OSDH Center for the Advancement of Wellness at 405-271-3619.
Additional information on poison prevention can be found at www.oklahomapoison.org.

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