Nolan Hunt
Week 1 Sturgis

If you travel over five hours west from Sioux Falls, passing through many quaint towns with interesting names, you will eventually come across Rapid City. Rapid City lies just on the foothills of Black Hills National Forest. I must admit, the Western side of the Missouri River is much more appealing to the eye than the flat, humdrum of the Great Plains surrounding Sioux Falls. Driving through Rapid City, I could not help but smile because I knew that in just 25 miles, I would land in my temporary home for the next four weeks. Sturgis is a town of over 6,000 inhabitants. The people whom reside in Sturgis have been some of the most welcoming individuals I have ever met. I was very apprehensive to journey to a town knowing very little people and having little-to-no idea of what I was getting myself into. However, upon meeting my partner, Sara, and most of the staff at Sturgis Regional Hospital, I can safely and confidently say that my four weeks here will be some of the best weeks since beginning graduate school.

Monday, the day of my arrival, was full of greetings, winding hallways that I was confident I would never remember, new faces, and medical terminology that most Master of Social Work students are not required to remember. For example, BUN which stands for Blood Urea Nitrogen. Aside from feeling completely overwhelmed, I was excited to dig my feet into this learning process.

Monday night, after the tour with Sturgis Regional’s CEO, Sara and I had dinner with Cheri at a local institution called The Knuckle Brewing Company—I would highly recommend the spinach and sundried tomato flatbread. After dinner, Sara and I met our host mother, Connie. Connie is an upbeat, warm and welcoming local who graciously took two strangers in. I consider myself to be fairly lucky in saying that for four weeks I will have a finished basement to share with Sara.

Tuesday was the day we dove head first into our experience. Sara and I began our day by meeting with the Director of Acute Care, followed by sitting in on the morning huddle with the days Nurses, Doctors, Physician Assistant, Pharmacist, Discharge Planner, and the Respiratory Therapist. As a Social Worker, the holistic approach this huddle encompassed was very fascinating to me and I really enjoyed getting to see many professions coming together to discuss the well-being of each patient in the hospital.

Next on our agenda was meeting the Director of Patient Care Services. This position works closely with the Director of Acute Care. Together, they help to shape and improve the quality of care that each patient receives when being admitted into the hospital. It is here that I suppose I should explain the type of services that Sturgis Regional provides. Sturgis provides a service that is called “Swing Bed”. This service is for patients who are considered to be “in-between” care. They do not need to be in the hospital, however, they also are not quite ready to go home. Swing Bed patients are allowed to stay in the hospital up to 100 days. The first 20 days are covered by Medicare 100%, days 21-100 are covered at a rate of 80/20. Any additional time needed in the hospital is up for review and patients can be sent to the Long Term Care facility adjacent to the hospital. To be considered for Swing Bed, a patient must need more than wound care. This means they would require a skill—Physical Therapy, Occupational Therapy, Speech Therapy, Respiratory Therapy, and so on. Most patients seen in the hospital are Swing Bed patients.

On Wednesday, I was able to meet a fellow Social Worker. The hospital Master of Social Work is also licensed as a Private Practioner. Cathy works with both the hospital and the Long Term Care (LTC) facility that is attached to the hospital. There are two units in the LTC—Massa and Berry. Together, they comprise an 84 bed facility. Cathy helps to find long-term placement for patients in the hospital and she also aids in providing the utmost care to the patients in the LTC. Cathy administers several assessment tools for the LTC residents—the PASRR, BIM, and the PHQ. All of these assessment tools are administered to each resident on both the Massa unit and the Berry unit. I was fortunate enough to administer the BIM and the PHQ to a resident on Wednesday under the supervision of Cathy.

Later that day, Sara and I both shadowed the Physical Therapists. It was here that I was able to interact more with the patients not just in the LTC but in the hospital as well. I had never been to a Physical Therapist prior to this experience so it was very eye-opening to see what they do and the amazing attitude each P.T. has with every patient/resident.

Thursday was a GREAT day! For the first time in my life I was able to be in a surgical room not once, but twice. Along with Sara, I was fortunate enough to stand in and observe two surgeries that day and meet the Doctors and Nurses in that area of the hospital. As a Social Worker, I will more than likely never sit in on surgeries so it was quite the experience to observe that realm of the medical world.

Sara and I met with the Discharge Planner later that day to discuss the role that she plays with each patient in the hospital. The Discharge Planner is the go-to lady for everything and anything that will help to ease the process of a patient going home. As a Social Worker, I related to her job very much. In both roles, we are expected to know where a client can receive the best follow-up care in the community and who they can contact for support and service. It was no surprise to me when the Discharge Planner expressed that finding adequate services in such a rural area can be a struggle—in particular, mental health.

Friday morning, I found myself sipping coffee in the Radiology Department playing an eye-spy game with 20-some year old X-Rays. There was something about a dark room and an eerie picture of broken bones and C.T. Scans that really intrigued me. I am hoping that as the weeks pass I can find myself staring at X-Rays again. I would really love to sit with the staff more and discuss how a Social Worker can play a role in this area of medicine.

Friday also entailed making rounds with the Physician Assistant and the Medical Doctor at the hospital. As I stepped in to each room with the P.A and M.D I found myself really wanting to sit down and talk with each patient in much more detail than time allotted. For myself, this is an obvious Social Worker trait—one that P.A.’s and M.D.’s do not always have time to use, mainly due to the time constraint and pressures that these professionals face every day. When asked, the P.A. and the M.D. informed me that they rely on Cathy, the Master of Social Work, to talk in detail with patients whom need additional care so all of their needs are met. It is with hope, I can step in and meet with some of the patients during their time at Sturgis Regional.

Our last stop on Friday was with the Health Information Management team. I feel I could write an entire blog post alone on this area of the hospital. However, I will say that billing, coding, release of information, program performance/improvement, dictations, and transcriptions all come from this department. I related to this area so much as a Social Worker and am hoping to spend more time learning how each hat they wear fits a Social Worker in the weeks to come.

Sturgis Regional Hospital is a 25 bed facility with two Intensive Care Unit beds and one room reserved for Hospice Care. In addition, their LTC is an 84 bed facility. In comparison to the major hospitals in Sioux Falls, this is a relatively small facility—and I like that, a lot. I am learning that although Sturgis Regional Hospital  be but small, she is mighty. As the weeks continue to pass, I hope to learn more about each area of the hospital and LTC and grow a deeper appreciation of how a holistic approach in the medical world is crucial to the success of every patient.

Week 2
Monday: My second week proved to be just as (if not more) insightful as the first week here in Sturgis. Due to Memorial Day, Sara and I did not have to work on Monday. Despite the rainy weather, Sara and I managed to get out and visit some of the local shops and restaurants in the area. Given the geographical location of Sturgis, Sara and I have been very fortunate to always have something to do outside of the hospital.

Tuesday: Tuesday, Sara and I spent our morning in the Cardiac Rehabilitation facility with Cassie and Amber. The Cardiac Rehab program is meant to help those who have a heart disease maintain a physically and mentally healthy life. Cardiac Rehab is comprised of three phases for patients. Phase one begins while the patient is still admitted into the hospital. Phases two and three take place after they leave the hospital. All phases are meant to help and support persons with heart disease reach a level of physical well-being that allows them to live a healthy and productive life.

Tuesday afternoon, Sara and myself observed in Long Term Care with several of the staff on both the Massa and Berry units. We met with the Director of Nursing on the LTC, Gayle, who went over the administration processes of the LTC. Gayle is in charge of most of the administration within the LTC. She works closely with all of the nursing staff, activities director and social services for the LTC. Sara and I were able to shadow the two med-aids for each unit and learn how medications are administered and the steps taken to ensure safety, accuracy, and ethics are upheld when administering medication. I shadowed a med-aid who was given the nickname, Frog, due to her love of frogs. Frog is a very upbeat and comical lady who seems to truly enjoy what she does. It was great to spend time with someone who not only enjoys their job, but is genuine with the residents.

Wednesday: I met with Cathy, the Master of Social Worker at Regional Hospital, to further observe and discuss her role in LTC and the hospital. Most of my morning talking with Cathy was focused on the role that Medicaid and Medicare plays in LTC. In summary, Medicaid and Medicare are intricate entities that can make taking care of a loved one a very challenging process. In LTC, both Medicare and Medicaid is accepted; however, there are several exceptions or certain “rules” that apply a certain distinction between the two. For example, those who are receiving Medicaid cannot have a single room—Medicaid will not pay for it. In addition, to be a candidate for Medicaid, you must spend down your assets to $2,000. These are just several examples of how Medicaid and Medicare work with LTC.

In addition to meeting with Cathy, I was able to sit in on a meeting to discuss LTC residents and administrative processes with all of departmental directors for LTC. The big focus of this meeting was to discuss care conference notes, physical therapy, available beds, medications, budgeting and discharge planning. This was very informative and I was reminded that in the world of health care-specifically social services- black and white are not the only options. I believe there is a lot of grey matter that needs to be explored in order to best meet the needs of clients.

Wednesday afternoon was filled with yet another meeting and activities with the LTC residents. The meeting focused on patient satisfaction and what can be done to make any additional improvements. I found this to be very interesting and I liked that several departments are part of this committee. The afternoon activities for LTC were in the Massa unit. Both units were invited to attend to participate in the afternoon activity with the local after school program children.

Thursday: Thursday morning was spent in Rapid City at a training for REHPS. The training focused on how to conduct a community health needs assessment. As Sara and I progress with our assessment, I will be discussing this further.

Thursday afternoon, Sara and I stopped at the Sturgis Coffee Company for a pick-me-up before heading over to our next appointment. Sturgis Coffee Company is definitely a must-do if visiting Sturgis. After fueling up on caffeine, Sara and I drove over to Aspen Grove Assisted Living where we met with Teresa and several of her staff to learn more about assisted living and how a Pharmacist and Social Worker play a role in that particular service. It was a great afternoon learning the major differences between Long-Term Care and Assisted Living.

Friday:
Friday morning, Sara and I assisted staff at the hospital blood drive. United Blood Services came to Sturgis Regional where we met some new faces and learned the processes associated with a blood drive. For myself, this was my first time being at a blood drive so I found it to be very insightful. I was unable to donate due to low hemoglobin levels; however, Sara was a rock star and was able to donate for a good cause.

That afternoon, Sara and I met with the hospital Registered Dietician, Fran. Fran provided great insight to healthcare and how a proper diet can maintain, improve, or prevent certain chronic illnesses. Fran gave Sara and I insight on local agencies and programs that assist individuals to maintain and improve their healthy lifestyles. Some of these programs include Bright Start, WIC, and SNAP.

Summary: As a Social Worker, it is important for myself and others in my profession to constantly be mindful of the whole person—not just the mind. Much like Psychiatrists and Psychologists, Clinical Social Workers are focused on the mind and how to treat it. Social Workers are also trained to take a holistic approach to treatment and to look beyond the black and white. With that said, I am thankful I can see so many shades of grey to help make the most ethical decisions and provide the best treatment possible to those who need it most. This week I was reminded that you cannot just look at one part of a person’s treatment—you really should be focusing on and emphasizing a holistic approach so a patient is receiving the utmost care.

Week 3
My third week in Sturgis was full of insight. Sara and I met with departments that we had not previously met with prior to this week. Sara and I were able to meet with Finance, Performance Improvement, Respiratory Therapy, Infection Control, and Administration. All of these departments allowed myself to gain much needed insight in to the realm of healthcare.

Not only were Sara and I able to meet with new departments within the hospital, but we were also able to meet with several agencies and individuals in the community. We met with entities from the school, community, and nonprofit sector in Sturgis; all of which provided insight into working and living in a rural setting. The lack of resources for mental health was a large take-away from these meetings.

Overall, I feel that Sturgis is not alone when it comes to limited mental health resources in a rural setting. The appeal that small town living provides brings but few candidates and agencies to the bidding block. The stigma surrounding mental health does not help this cause either. I have noticed that the stigma does not just lie with those diagnosed with a mental illness. It truly saddens me that Clinical Social Work has not gained traction in the healthcare world. I know it is a field that has gained more acceptance; however, after this week I realize that advocacy for the Social Work profession still needs to take place so that those who truly need services can receive them without feeling stigmatized.

Week 4
My fourth and final week in Sturgis was a little more laid back than my previous three weeks. Sara and I were able to get out of Sturgis for two days and explore what services Spearfish has to offer in world of healthcare. It is safe to say that Spearfish is not a rural community by any means; however, their hospital is connected to Sturgis because they fall under the same organization- Regional Health. It has become very apparent over my four weeks here that the residents in many of the surrounding communities utilize the Sturgis, Deadwood, and Spearfish facility to ensure their needs are met. If you cannot have your medical needs met in those facilities then one will need to travel to Rapid City.

On Tuesday, I spent my day following Triston, a Case Manager with Behavior Management Services, Inc. around Butte County meeting a wide variety of faces and places. It was a very eye opening experience for myself as a Social Worker and an intern. As a Social Worker I have never personally worked in the field of case management so I found this experience to be very enlightening. As an intern, I was able to see how a case manager’s position plays a pivotal role in connecting a client with the proper medical services needed. In fact, several of the clients we met with that day were also seeking services through Sturgis Regional. To see the medical services in the area come full circle put my role into a little more perspective.

Wednesday, Sara and I ventured to Spearfish again to shadow professionals from Home Health & Hospice at Spearfish Regional. The only experience I have had with Hospice was when my grandmother passed away from cancer in 2008. I can remember that person becoming a vital part in my grandmother’s final days. That particular Hospice staff provided the healing and comfort we, as a family, needed during that time of grief. When I followed Bruce, the Hospice MSW, I could see those same emotions coming to surface with those families as it did for my own. It was a remarkable feeling to know that I could potentially be someone a family or individual confides in during their final days here on Earth.

Our last two days were filled with bittersweet goodbyes and last minute “to-dos” while in the Black Hills. My experience at Sturgis Regional and in the Northern Hills has been one for the record books. I cannot begin to describe how fortunate I feel to have met so many wonderfully compassionate health providers. The REHPS program has allowed me to see the potential the healthcare system has in our society and the role that each professional plays independently and interprofessionally to ensure that a client receives the best service possible. I hope to take what I have learned in these four weeks with me as I continue to foster my growth as a professional.