Nurse-clinician Gisèle Poirier was working at the McGill-Bonneau Nursing Clinic when a case worker introduced her to a man who was hesitant about receiving treatment. Poirier runs the two-day-a-week nurse-led clinic at the Accueil-Bonneau residence, which opened in 2017. She and her rotations of six student nurses serve the organization’s three facilities that house men at risk of homelessness. The man eventually agreed to have Poirier check his vitals. “I took his blood pressure and it ended up being dangerously high.” She recommended that he go to the hospital, but he chose to stay put.
Despite that reluctance, Poirier was able to see him at weekly follow-ups and begin to nudge him toward taking better care of himself. “Within a month, he agreed to see a doctor, and he was started on blood pressure medication.”
Since then, she has seen the man show up every week at her clinic. “He would arrive early with his newspaper and just wait. He was super eager.” She is happy to now report that his blood pressure is normal. He has also been seeing a physiotherapist and doing daily exercises to help treat a partial paralysis.
McGill-Bonneau’s success of reintegrating clients into the healthcare system while teaching students community nursing practices is now being replicated in five new locations, thanks to funding from Sun Life. The $800,000 donation helped open two-day-a-week clinics at the Open Door, Chez Doris, the Native Friendship Centre, the Native Women’s Shelter, and the Old Brewery Mission. Two additional nurse clinicians, Alex Magdzinski, MSc(A)’17, and Lucie-Catherine Ouimet, oversee the first four clinics, while Poirier has taken on the last one. The five new clinics opened in January of this year. Like the inaugural clinic, they provide care to underserved populations, with a focus on diabetes-related health promotion, screening and direct care. They also create opportunities for experiential learning and clinical-skills training for nursing students.
Since it opened, the McGill-Bonneau clinic has registered 1,800 visits from 168 patients, most of whom have come in for more than six visits each, according to recent data. (There is no available data yet on the new clinics). While the staff does not prescribe medication, they do see patients for a variety of conditions, with the majority coming in for diabetes and hypertension follow-ups. Other reasons for visits include general assessments, skin conditions, mental health and respiratory follow-ups. More than half the population seen are dealing with a drug or alcohol dependency, while 64 per cent have been diagnosed with a psychiatric disorder.
Françoise Filion says this target group deals with unique issues. “They often feel excluded from the healthcare system,” says the ISoN professor and Assessment, Research and Evaluation Lead for the Community Nursing Clinic Network (CNCN). Hugo Marchand, BN’13, also an ISoN professor, as well as CNCN Project Director, adds that those who have been marginalized usually don’t even have health insurance cards. He says they have lost their link to the healthcare system. “The role of these clinics is to recreate that link.”
Filion says the clinics strive to go beyond medical treatment and what hospitals could do, by reintegrating the patients through simple acts, such as helping them obtain new ID or speaking to their physician at an appointment. “People in this population would never have this care or this service if we didn't have these nurse-led clinics.”
There’s something else the clinics’ nurses and nursing students address, namely loneliness, says Poirier, who adds that the appointments provide an important break in her clients’ sense of isolation. She sees special connections taking place between student nurses and clients. “The patients start to care about themselves because we care about them,” says Poirier. “I tell the students that the time they give to them makes a world of difference, that they look forward to it.”
Working at these clinics also expands the student’s view on the nurses’ scope of practice , say the three who all shared the Grand Prize of the 2019 National Bank Clinical Innovation Competition of the Ordre des infirmières et infirmiers du Québec for the McGill-Bonneau clinic that appears to be the only one of its kind in the country. One student, recalls Poirier, had been meeting with a patient who had a problem with alcohol. “He told her ‘I don’t want to drink anymore.’ The student really took this one on. She monitored her patient and ended up finding a place where he could do a six-month rehab.”
While the patient in the above example would eventually relapse, even that disappointment helped the student learn that there is just so much a nurse can do when it comes to substance use. “Our goal is to practice harm reduction.”
The Sun Life funding covers the costs of three nurse-clinician salaries and medical supplies until 2024. It is also improving the scant numbers of available clinical placements for nursing students and addressing the rising needs of Montreal community-based organizations, many of which have been unduly affected by the pandemic. Filion and Marchand see several opportunities for graduate students who may want to study diabetes or co-morbidities using data emanating from the clinics. One student presented posters about the community clinics at a couple of local and national conferences. The project hopes eventually to welcome nurse practitioner students, as well.
The results—integration of an underserved population, increased training opportunities for students, and stronger partnerships with community groups—speak for themselves, and continue to raise the bar for community nursing at the ISoN.
Reprinted with permission from FMHS Focus.