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Curious, caring, compassionate: three characteristics of an aspiring respiratory therapy student

By Ashley Skinner

Death: a fact of life Texas State University senior respiratory therapy student Jacki Brewer is becoming familiar with as she takes on her career goals of becoming a respiratory therapist.

Brewer calculates the right dosage of medicine to give to a young patient in the emergency room at Georgetown Public Hospital. Too much medicine can cause complications, such as more difficulty breathing.                                                           Photo by Ashley Skinner/Global News Team.

“Of course I get scared and worried when things start to go wrong,” Brewer said. “You’re always going to worry about your patient, but the best way to put those bad thoughts aside is focusing on how to make the patient stable. You can’t worry about your feelings or yourself.”

When a patient’s family decides to take him or her off life support, a respiratory therapist is the one who disconnects the patient from the machines. For Brewer, this comes at a cost.

“Personally I step aside and get some fresh air,” Brewer said. “I’ll go pray and take a few deep breaths to clear my head. You can’t let it affect the rest of your day or you because you have other patients too. Your patients are your priorities; you can deal with yourself later.”

Brewer came to Texas State in 2014 from Carrollton, Texas. She chose Texas State because of the location between San Antonio and Austin, and because she felt like she immediately fit in on the campus.

Upon entering college, she did not know exactly what she wanted to do. However, once she realized there was a respiratory therapy program, her search for a major was over.

“In high school I was a home health aide and I took care of this really sweet, elderly lady,” Brewer said. “That experience paired with my asthma history is why I wanted to get into the field. I did my research once I heard about the profession at Texas State and I decided I wanted to be a part of that profession.”

Sharon Armstead, clinical assistant professor for respiratory therapy at Texas State, said Brewer is meant to be a respiratory therapist.

“She’s not scared to ask questions,” Armstead said. “She’s curious and shows initiative, and she isn’t afraid to take control of tough situations. That’s what a respiratory therapist needs to be.”

In January, Brewer went on a study abroad trip with Armstead to Guyana, South America, where she worked on patients with breathing issues in Georgetown Public

Brewer works alongside a doctor at Georgetown Public Hospital, attempting to stabilize a patient in the CICU.
Photo by Ashley Skinner/Global News Team

Hospital . Within 10 minutes of Brewer entering the cardiac intensive care unit (CICU), a patient began to show signs of being hypoxic: a condition in which the parts or regions of the body are deprived of adequate oxygen supply.

“I was really scared, this being my first time in their hospital with their equipment that I wasn’t familiar with,” Brewer said. “Once I got into it, I wasn’t scared and I think I handled it well. We got his stats back up and that’s all that matters.”

Armstead said at first she was worried about having Brewer in the CICU alone, but was impressed with how well she handled the patient with such urgency and care.

“She noticed the settings on the ventilator and that the patient was hypoxic immediately,” Armstead. “She bagged the patient. She suggested what changes should be made. She took control and she cares. That’s what I like about Jacki.”

Stephanie Kelley, senior respiratory therapy student at Texas State, went on the trip to Guyana and worked closely with Brewer while they were in the hospitals. Kelley also noticed how caring Brewer is with her patients.

“I don’t think anyone else is as observant as Jacki,” said Kelley. “She cares about her patients and people in general, and that’s one of her best characteristics.”

Listening to a person’s breathing before a treatment versus after, Brewer said, is a very rewarding feeling, as is being able to take a healthy person off of a ventilator.

“Their lungs go from sounding wet and crackly to sounding dry and clear and that’s proof of the work you’re doing,” Brewer said. “When someone is on a vent and is able to extubated, you get to take that tube out of their throat.  The first thing they say is ‘oh my goodness that feels so much better, thank you’ and hearing those words is the most rewarding part of my job.”

Above is a video of Brewer helping a doctor draw blood from a patient to test the level of gases in his blood.

This video is of Brewer aiding a nurse during a hospital-wide oxygen shut down. 

Videos by Ashley Skinner/Global News Team. 

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How traveling to Guyana changed me as a student

By Katie Burrell

I went on a trip out of the U.S. with the goal that I would learn to be brave and independent.

Having only left the country once before on a family cruise to Mexico, I knew I was missing out. As a completely unseasoned traveler, my worldview was sculpted from growing up in North Texas, moving back and forth to Oklahoma and a couple days in the most touristy spot of Mexico.

However, as a journalism student, I’ve made it a priority to diversify my friendships, read stories by other people about other places and cultures and to always look at the planet with an open mind. This mantra, albeit harmless, was insufficient. Reading and listening to others’ ideas and experiences can keep a student keen, but now I know life is learned best when experienced firsthand.

So, I spent two weeks in Guyana with five of my peers from the mass communication department, and five students I had never met before from the College of Health Professions at Texas State. I flew on a plane for the first time, in the aisle seat of course, from San Antonio, Texas to Miami, Florida and a major layover later I was in Trinidad/Tobago then to Georgetown, Guyana.

I experienced so many firsts within those 24 hours-my first plane ride, my first-time on the other side of the U.S., my first time meeting some of my trip mates and my first time feeling completely elated knowing that I had no idea what the next few days of my life would look like.

We got off the Caribbean Airlines plane and immediately stepped foot on black pavement, surrounded by darkness, stars and humidity. Straight through customs, baggage in tow, we were through the small airport and welcomed by a camera crew. I talked to fellow journalists for a quick online segment that was posted the next day, and squished myself into a van for a bumpy, and what felt like forever ride to Project Dawn. We stayed at Project Dawn, a large hostile in Liliendaal, Guyana for the majority of our trip.

Project Dawn is where I made spaghetti one night because we were too exhausted to go out. It’s also where I learned to play gin rummy, met a Canadian anesthesiologist, ate countless meals of chicken and rice and learned the value of being far away from home sometimes.

I wanted to be a more adventurous student. I wanted to consider myself a brave traveler and well-rounded journalist and I hope I am still on my way to be all of those things. But what I really learned on this trip, following students around in hospitals, interviewing locals and hanging out with school children was that my whole life is not in Texas. I discovered that I felt most at home when up late at night discussing sources with my roommate, fighting off mosquitos in the Guyana interior and laughing too loudly in a bumpy van.

My trip to Guyana was not easy and each day presented a new challenge but with the help of my peers I felt at home because I was thriving as a student. I learned firsthand what it really means to be open minded to the world and to myself. The culture of Guyana bears its similarities to the U.S. but is overall so different, and I’ve learned to embrace that.

Desiree Davis: A personal journey providing healthcare services in Nicaragua

By: Allison Fluker

Desiree Davis was sitting in the window seat of the 28th row on the plane headed for Managua, Nicaragua, that would take off Jan. 2. Her pink neck pillow hugged her neck as she quietly waited for the plane to take off.

Davis is from San Antonio, Texas. She is senior at the St. David’s School of Nursing at Texas State University.

At first glance, she looked calm.

When the plane lifted off from Austin, Texas, she let out a small scream as the air pressure popped her ears.

A team of 24 students from the Texas State University College of Health Professions was on its way to collaborate with the International Service Learning organization in Nicaragua to set up free medical clinics in small villages outside of Masaya.

When Davis found out about the trip last year, she didn’t hesitate to apply.

“We’re so used to being in America, it’s forcing us to have to embrace a new culture we’re not used to,” said Davis after spending a day seeing patients in La Borgoña. “It is important to connect with people who are not like me.”

Davis’ determination to get outside her comfort zone caught the attention of her friends and colleagues.

“She’ll take the opportunity that’s most challenging,” said Madeline Longtin, a senior in the nursing program. “Even if she’s scared, she likes to push her boundaries to see where her limits are.”

Davis does not speak Spanish, but was called on to communicate with patients in their native language. Her nervousness was evident, but she overcame that obstacle and looked people in the eye and nodded her head in understanding.

A Life-Long Dream

Healthcare has always been important to Davis.

During her senior year of high school, she participated in a certified nursing internship at local hospitals and in nursing homes. Her dream job is to be a pediatrician.

“I love working at the bedside with patients,” Davis said. “I love to be there for people and to take care of them.”

Davis has a strong will for taking care of people. When she graduates college, she wants to work at Brackenridge, a level-one trauma center, in Austin, Texas. She ultimately wants to work in an intensive care unit.

“Level one is when you get the most critical patients, like from air support,” Davis explained.

Davis’ love and compassion for patient care have not gone unnoticed from her peers.

“She has so much joy,” said Longtin. “She cares so much, beyond words.”

Davis’ joyful attitude and pleasant demeanor makes her patients feel comfortable and at ease.

“She’ll help you out before she takes care of herself,” said Rebecca Duffy, a senior in the nursing program.

How the Clinics Worked

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Davis and her colleague completing a census form during home visits in La Borgoña. Photo by Allison Fluker.

On Jan. 4, the health professions team was split into three groups and named themselves: Group Peanut, Group Butter and Group Jelly. Each group followed a community leader into the villages to visit residents in their homes and take a medical census. They used this opportunity to invite community members to the clinics, which were held in local churches.

Davis’ group – Jelly – went to La Borgoña, a community near Masaya that received three free clinic days.

“There was a reason why we were there,” said Davis. “We were there to show them love.”

 

The local residents attended the clinics to receive care for illnesses ranging from diabetes to allergies.

During the operation of the clinic, the health professions students split into groups of two and, with a translator next to them, conducted focused assessments on the patients who had lined up outside the church to be seen.

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Davis completing a focused assessment form. Photo by Allison Fluker.

Davis exuded confidence expected from a seasoned professional. A curious fire raged in her eyes when she consulted with patients.

“You start to see the same illnesses and know the right questions,” said Davis. “It gives you a lot of confidence.”

By the third day of the medical clinics, the previously nervous students grew confident and eager. Their confidence was built, in part, by consulting with the Nicaraguan physicians who pushed the students to utilize the knowledge and skills they learned in nursing school.

“You’re able to sit down with the doctor, tell them what is going on with the patient and you’re able to give your own assessment,” said Davis.

 

Some students began to assess patients without one of their colleagues by the third day of clinics.

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Davis filling a prescription after completing a consultation with a patient. Photo by Allison Fluker.

“I was by myself the rest of the day,” said Davis. “I began to ask questions like ‘Has anything changed in the last 6 months?’ A lot of education went into finding out what happened to some patients.”

One patient stood out to Davis. The woman they were performing an assessment on who already knew what was going on with her health.

“We had a 47-year-old woman that was diabetic who was diagnosed 13 years ago,” explained Davis. “When we took her blood sugar, it was 448. In that moment, she automatically knew it was high when we showed her. She started to tell us how stressed she was. Her son had just gone to jail. While my partner, Mady, was taking her blood pressure, we started hugging her and holding her. You could tell she was just so stressed out. We asked Harold, our translator and ISL assistant team leader, to take her to the hospital with one of the buses.”

 

Giving Back

After the three days of clinics ended, the health professions team returned to the village, Chocoyera, to give back to their community. Everyone in the team went to the store earlier in the week and bought things for the children to play with.

“There were tons of kids,” said Davis. “Everyone was so comfortable with each other. Some of us started blowing up balloons inside (the church) and others set up the health fair outside when we arrived.”

Some students played with children from the community while other health profession students set up a couple of tables outside the front of the church. These students would continue to take blood pressures for local residents and give smaller focused assessments.

“I played with a little girl named Carmen,” said Davis. “She was teaching me little words (in Spanish) the whole time. I asked her what she wanted to be when she gets older and she said ‘doctor.’ I had brought a doctor play set with me and I decided to give her the doctor set. The smile on her face was so breathtaking.”

Davis special moment with the little girl, Carmen, is a small reflection of the experiences many of the other students had that day.

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Davis playing with a bowling set and a young girl during the community give back day in the village of Chocoyera. Photo by Allison Fluker.

The study abroad to Nicaragua was brief. The health professions team flew out of Austin, Texas, on Jan. 2 only to return on Jan 13. In that time, the students traveled to small villages outside Masaya, a nursing home and to a children’s home. Throughout their time abroad, they performed hundreds of focused assessments and impacted many lives.

“We’re walking into a place where people didn’t choose that lifestyle,” said Davis. “It’s important to count your blessings because you don’t know what that person is going through.”

Davis went on the trip not knowing what was going to happen but she returned home with a bigger understanding of the world, healthcare and the knowledge that she made an impact in so many people’s lives.

“It is impressive to see the locals have so much joy in them even though their situation might not be the best,” said Davis.

Texas State nursing students experience Nicaraguan hospitality

By Alicia Vazquez

When the St. David’s School of Nursing students from Texas State University signed up for two weeks of volunteer service at a third world country, they knew it wouldn’t be the same as providing healthcare in the United States.

What was not completely expected was that the experience would require them to use skills from their first days of nursing school and provide an opportunity to immerse themselves in the culture through the Nicaraguan people.

Stepping out of the comfort zone

Elizabeth Biggan, clinical assistant professor at St. David’s School of Nursing, said she prepares the students by talking to them about the poverty that they’ll see. She also shows them videos from previous trips, but she can’t fully prepare them for the clinics.

“Every bit of school that they go through at home is in a hospital where all equipment is readily available. All medications are readily available,” Biggan said. “It’s hard on the students to have a patient who needs medication, but they don’t have it and they have no way to get it. They really have to learn to adapt to the situation, but they also learn to get creative with their solutions.”

Nursing student Anastasia Houze listens to a baby's heart during the Campuzano community clinic. Photo by Alicia Vazquez
Nursing student Anastasia Houze listens to a baby’s heart during the Campuzano community clinic. Photo by Alicia Vazquez

Experiencing those situations is what makes students’ nursing skills grow. In the Nicaragua clinics, they can’t rely on machines for reassurance.

Students manually check vital signs like blood pressure and temperature, something most haven’t done for four semesters. Biggan said this is where students step out of their comfort zones and learn to trust themselves.

The language barrier

The nursing students ranged from feeling confident with Spanish, to remembering some words from Spanish class in high school, to not knowing any Spanish at all. Some prepared for the clinics by studying the anatomical terms in Spanish. Others had to learn on the spot or rely on the translators, but the difficulty was part of the volunteering experience.

A young patient and nursing student Bridgette Young exchange smiles before beginning the health assessment.
A young patient and nursing student Bridgette Young exchange smiles before beginning the health assessment. Photo by Alicia Vazquez

“The first house visit was mostly people looking at me and at one point even laughing, like ‘what is this girl saying?,’” said nursing student Bridgette Young. “By the end they were really understanding me and actually answering back without the translator.”

Massiel Acetuno, assistant team leader, said it’s difficult for the students to have social conversations when they’re not able to fully express themselves in the foreign language.

The students used their broken Spanish, hand gestures, facial expressions and voice pitch as they tried to make connections with the people.

“Volunteers try to do signs or play with the kids to bond with them,” Acetuno said. “Sometimes I feel helpless when I see them struggling with language but I like to see that even though they’re not speaking the same language, it’s like their souls connect.”

When people of different cultures meet

Acetuno, who is constantly introducing new people to her culture, said she enjoys it because it’s her chance to tell people why she’s so proud of being Nicaraguan. Acetuno describes Nicaraguans as people who welcome visitors and who receive them as family members.

“I love the most when we go to house visits and clinic days and they’re able to see by themselves that I wasn’t lying, that everything I said was true,” Acetuno said. “People still welcome you even though their houses are really poor, they always say to you ‘come in’ without any fear, without any doubt.”

The house visits to the communities are the first opportunity that the nursing students get to interact with Nicaraguans.

“They’re going to give you all the chairs for you to sit down. These people are so nice, so selfless,” nursing student Jessica Ramirez said. “They don’t have a lot to offer but they still keep offering.”

A baby boy stands in his crib at the Campuzano community. Photo by Alicia Vazquez
A baby boy stands in his crib at the Campuzano community. Photo by Alicia Vazquez

International Service Learning, the organization that plans the volunteering trips, identifies rural areas where healthcare is not easily available. This means that the conditions will be some that the students may not have seen before.

There were latrines, houses with dirt floors and without doors, wood cribs and unpaved roads. Despite the conditions, Nicaraguans displayed something else to their visitors.

“Happiness. They only show how grateful they are for the things that they have,” Acetuno said. “You may not see in their faces pain or sadness. You may not see depression, but most of the people that we see in the communities have huge problems. Sometimes they don’t have anything to eat that day.”

On the final day at the communities, the students handed out rice and beans, played games with the children and broke a piñata. It was a day to forget about nursing work and interact with the community they had been helping.

“I think the most difficult thing was giving the families rice and beans,” Ramirez said. “When we handed the parents food, that was real. We were giving them a means to survive for a week.”

Acetuno said that at the end of the trip it’s not just about helping people but also about taking the time to understand their situation, understand their history and why they are the way they are.

For nursing student Rachel Nading, leaving Nicaragua was the most difficult thing.

“I feel like it’s not enough. I feel like I could do more,” Nading said. “More in medical care, in treating people, just more.”

A girl waves goodbye at the nursing students after they finish conducting the health census at her home. Photo by Alicia Vazquez
A girl waves goodbye at the nursing students after they finish conducting the health census at her home. Photo by Alicia Vazquez

Tending to More Than a Physical Illness

By Alicia Vazquez

Michelle Juarez arrived at Hogar San Antonio – a nursing home in Nicaragua – with her fellow classmates of the St. David’s School of Nursing at Texas State University on Jan. 16.

Like the rest, she walked into the infirmary and soon noticed the single patient who lay in a bed. Her name was Petrona and she had been at the nursing home since 2007.

In the two weeks prior to the team’s visit, Petrona’s kidneys had started to fail her. Juarez had been taught that once the kidneys go, everything goes.

Petrona was now in sepsis and had anasarca all over her body. She was in hospice care, but her family didn’t want her to receive any other type of care. The only thing she was getting was normal saline to keep her hydrated. She couldn’t drink anything because of the risk of aspiration pneumonia.

Knowing that Petrona’s mouth was probably dry, Juarez went for a gauze, moistened it with water and swabbed Petrona’s mouth. Another student gave Petrona drops of water.

Petrona’s sounds from her struggle to breathe filled the room. Petrona needed oxygen. She didn’t have it. She needed pain relief. She didn’t have it. She needed someone to hold her hand and comfort her. Petrona would probably pass away in her sleep, so Juarez prayed for her and loved her in every way that she could.

As a senior in her last semester of nursing school, Juarez will soon be in many more situations similar to Petrona’s because she wants to be a critical care nurse. She said that being Petrona’s nurse that morning helped confirm her decision.

“When you’re a student you have no clue as to how you’re going to be as a nurse, you need that confidence, so caring for her honestly made me feel great that I know what I’m doing and that I can handle this,” Juarez said. “My desire to help critical patients is stronger than my desire to go cry in a corner. I don’t do that until later.”

The fast pace of the emergency room and intensive care units give Juarez an adrenaline rush.

“It’s just something about having to learn every day,” Juarez said. “You don’t know what’s going to happen but you’re ready to be there.”

One of Juarez’s reasons for pursuing a nursing career is because her little brother has Down syndrome so she was exposed to the medical environment at a young age.

Juarez will be the first person in her family with a four-year degree and now that she’s about to graduate, her parents, little brother and patients give her the drive she needs to continue.

“Every single patient that I have encountered, I remember their stories. I remember their family. I remember their faces,” Juarez said. “And it’s not easy. It is the hardest thing I have done in my entire life, but it’s definitely worth it. If you ask any of us, we all have patients that have stuck with us already and we’re not even nurses yet.”

At 21 years of age, Juarez is one of the youngest in her nursing class, but that doesn’t stop her from being a leader.

Shawn Boyd, clinical associate professor at Texas State University, said that Juarez has the three skills that professors look for in nursing students: critical reasoning, dexterity and caring. Although the third skill, being caring, can be tough to teach, Boyd said that’s what makes Juarez stand out.

“She looks patients in the eye. She uses touch. She does all those things that might be somewhat uncomfortable for some people. She is an exemplary student,” Boyd said.

Juarez often chooses the most difficult cases to challenge herself. She takes the sickest patients. She takes initiative. She is confident. She doesn’t doubt her nursing abilities. Yet, Juarez is humble and loving toward everyone.

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Juarez walks a woman who turned 110 years old the previous day.

While in Nicaragua, Juarez helped her peers improve their Spanish and even cooked dinner for more than 30 people. She bought snow cones for kids at the San Joaquin community and gave her backpack to an elder at the nursing home after he asked if she could bring him one the next time she visited.

“I don’t have anything to lose by giving someone something that I don’t need,” Juarez said. “The man then said ‘Que Dios te bendiga’ (God bless you). The happiness that I gave him is unmeasurable.”

For Juarez, the best part of her day is talking to her patients.

Boyd saw that eagerness in Juarez and describes her as a patient advocate. Boyd sees Juarez as continuing to do work with people who do not speak English either in Latin America or on the Texas border, contributing for those who are underserved.

Alexandra Orzech, nursing student and fellow classmate, said it’s important to Juarez to protect a patient’s dignity. Juarez is respectful: she explains what she’s going to do before starting. And she is a good listener to her patients.

“I think she’s going to be an awesome nurse. She’s book smart but she’s also personable. When she’s with patients you can tell there’s more than a textbook behind her knowledge,” Orzech said. “She’s very at home at the hospital. You can tell that’s where she’s supposed to be.”

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Juarez plays with a child in a crib during the home visits at the Campuzano community.