By Allison O. Adams

As health care changes, Emory nurses
are practicing in unfamiliar settings

Where the Action Is

Early one Monday morning, a fifteen-year-old girl enters a yellow cinderblock classroom at Booker T. Washington High School in Atlanta's West End. Two months pregnant, she has hopes of someday becoming a lawyer, but the baby's father has vanished, and she knows she is not ready to raise a child alone. She also faces the daunting task of breaking the news of her pregnancy to her mother, who had her first child when she was only thirteen.

The student has come to the high school's Adolescent Health Station, a project sponsored by the Nell Hodgson Woodruff School of Nursing. She is seeking the advice of Janice Daniels and Sandra Leonard, the two Emory nurses who run the station. Daniels and Leonard talk with her about ways she can communicate more effectively with her family.

"Sandra and I give her a place to talk about [her situation]," says Daniels. "She knows she can come in here and get a hug and not be preached at. We can't save her life, but we can give her a little life raft-we can teach her some skills for dealing with people in authority."

The Adolescent Health Station, a five-year program begun in January 1996, represents the Woodruff School of Nursing's efforts to strengthen its presence in the community and to explore the changing role of nurses in preventive health care. It also provides Emory with a laboratory and clinical site for an innovative model of health care delivery.

Nursing school Dean Dyanne Affonso, who worked for fifteen months with high school officials and community leaders to conceive the project, says the traditional medical model "is not good enough any more. It's not culturally sensitive; it has an imposing character to it. So as new paradigms emerge, we will be giving care in unfamiliar settings. Instead of hospitals and clinics and doctors' offices, we will be in the community, in places like Booker T. Washington High School, because that's where the action is in the life of a teenager."

Of the more than fourteen hundred students at Washington High School, the city's first public school to admit African-American students and the alma mater of Martin Luther King Jr., some 130 are pregnant or already parents. Twice a week, midday at the health station is set aside especially for students who are pregnant or new mothers. Daniels and Leonard, both advanced-practice nurses who launched the program, talk with forty to fifty of those young women about managing motherhood. They engage the group in a steady stream of chatter about due dates, ultrasounds, school assignments, child care, teachers, and their own parents.

While teen pregnancy is a significant concern at Washington High School, Daniels and Leonard also address issues of loss and grief among the students, whose urban lives are frequently disrupted by violence; students' interpersonal relationships; and problems related to the school's low retention rates, especially among ninth-graders. Ultimately, they hope to respond to early warning signs of depression, substance abuse, violence, and suicide.

The health station nurses are not there to provide traditional "school-nurse" medical care. Instead, they concentrate on the psychosocial needs of students. Absenteeism and tardiness are warning signs they watch for, and they ask Washington High teachers to refer habitually absent or tardy students to them for counseling.

"If a kid can't do what is essentially his job for eight hours a day, then there's something going on that he's not able to cope with," says Daniels, who earned her master of nursing degree from Emory in 1995.

Leonard concurs. "The problems they deal with every day have more of an effect on their health than substance abuse and violence," she says.

"And all the research shows us that initiatives that have a positive impact on adolescents usually involve one-on-one or group encounters with adults or peers."

The nurses address students' most pressing problems. A "Lunch and Learning" series offers the opportunity to discuss domestic violence, anger management, drug abuse among friends and family, and advice for teen fathers. One Saturday last fall, twenty female Washington High students and their mothers attended a half-day workshop to help improve their relationships. When a student was shot and killed on campus last year, Daniels and Leonard offered grief counseling and organized a memorial service. They have also begun to work with leaders in four public housing projects near the school to help parents develop a program to control truancy.

Since the Adolescent Health Station was established, nursing school faculty and students have grown increasingly involved in its efforts. A student pursuing a master of nursing degree recently worked with Daniels and Leonard to organize a personal hygiene workshop for residents of one of the nearby public housing projects. Nursing and public health faculty are planning research projects centered at the high school, and the health station will soon serve as a clinical teaching site for undergraduates.

For bachelor of nursing students who are taking Nursing 499, the required course in which seniors work in teams on a community service project, the health station often provides a focal point for their work. Recently, one team of Nursing 499 students collaborated with Daniels and Leonard to help pregnant students improve their own health and their babies' birthweights by developing personal nutrition plans tailored to the students' individual preferences and resources.

"They're supporting their future and their babies' future," says Leslie Brooks, an Emory senior who wants to pursue neonatal nursing. "If a pregnant teenager is not getting some essential nutrients, the baby will wind up in the neonatal intensive care unit [because of low birthweight], and the mother may get early-onset osteoporosis."

Another group taught a series of lessons to a Washington High class on how to gain access to health care. "We're helping teenagers get in the front door, utilize the free clinics, and stay away from the emergency room, and we're educating them on the various payment plans like Medicare, Medicaid, HMOs, and insurance," says Amy Thom, an Emory nursing senior. "Adolescents are traditionally an underserved population. We want them to know health care is available and within their reach; it just may take a little bit of know-how and some assertiveness."

Both the Adolescent Health Station and Nursing 499 exist in concert with the mission of the nursing school, says Affonso. "Part of our mission is to design innovative health care programs and to take Emory nursing out into the community. That's what our students are doing, and it's what the health station is. But we must work in partnership with the community, and it's up to us to prove we're a worthy partner. If I don't know your community and I design a program for you and then demand that you comply because I'm the expert and I say it's good for you, I'm doing more harm than good."

Daniels echoes this idea, adding that such partnerships require long-term institutional relationships. She and Leonard have applied for a grant to secure the health station beyond its original five-year commitment. "Sandra and I are in the school, and we've been meeting with people and finding out what they want. We're just beginning to understand what the problems are and gain the trust of the folks here. You've got to have that relationship."

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