During the COVID-19 pandemic, doors have been closed all over the world.
But for College of Saint Benedict and Saint John’s University student volunteers in the Hospital Elder Life Program (HELP) at St. Cloud (Minnesota) Hospital, doors have also been opened – both in-person and remotely.
“We’ve piloted and expanded the HELP program and are launching a new course to support this program and tie its opportunities to classroom learning,” said Chris Bolin, visiting assistant professor of English at CSB and SJU.
During fall semester, five CSB and SJU volunteers connected (both on-site and remotely) with patients admitted to St. Cloud Hospital to explore creative writing and have stimulating conversations to prevent the onset of delirium in at-risk patients. During spring semester (B block), the number of CSB and SJU volunteers will swell to 25.
“For patients who are in the Intensive Care Unit, the incidence of delirium is up to 80%,” said Evalyn Michira, a clinical nurse specialist in the St. Cloud Hospital medical section. ‘It does significantly impact their stay here in the hospital. It does impact their treatment, and it also impacts their life overall, once they get discharged. Some patients also do end up developing dementia after developing delirium.”
That’s where HELP comes into play. Originally developed at the Yale School of Medicine, it has been shown to reduce delirium rates by as much as 30%. At St. Cloud Hospital, the program is administered by CSB, SJU and St. Cloud State University students – especially those interested in a medical career.
“Basically, what they (the volunteers) do is come in, interact with patients and just keep them engaged and active during the day,” Michira said. “Hopefully, that will keep the patients’ engaged and they’re sleeping at night. And that, in and of itself, is a huge aspect of delirium prevention.”
Lily Miner, a CSB junior psychology major from Minneapolis, described what a volunteer shift typically looks like.
“It starts with communicating with nurses and hospital staff to get organized for the visits with patients,” Miner said. “In the patient interactions, I like to give them a brief introduction on the HELP program, who I am, and why I have interrupted their day.
“If a patient seems interested and able to talk, I like to sit down in their room and chat with them about whatever they like. We often talk about their families, their fond memories or their childhoods. If the patient feels up for it, we introduce some poetry/creative writing into the conversation,” Miner said. “In addition, I connect other students who are part of the program on campus, to patients via an iPad. With visitor restrictions in place at the hospital due to COVID-19, the volunteers are sometimes the only outsiders they see.
“I have found that having these conversations with patients makes them feel heard and gives them some normalcy during their hospital stay,” said Olivia Hoff, a CSB junior from Rushford, Minnesota. “In a place where conversations are dominated by their health concerns, it is nice for patients to escape that language for a few minutes and reflect on their accomplishments, experiences and to get excited about returning to their life outside of the hospital.
“During the interactions in which we write poetry together, this is even more of an escape into an imaginative place outside of the patients' hospital room,” Hoff said.
Nicole Dueland, a CSB senior from Cold Spring, Minnesota, reflected on a patient she worked with this past fall.
“One morning while speaking with the charge nurse, they informed me about a patient who they thought would be a good candidate for the HELP Program,” Dueland said. “The patient had been expressing to nurses that he was feeling lonely and sad while at the hospital. I went into the patient’s room to explain the HELP Program and see if he was interested. He was hesitant and unsure if he would have enough to say to a student but agreed to meet with one of our students, Abby, on the iPad.
“After the conversation, the patient told me how much he enjoyed the conversation and he told me, ‘You have no idea how much that helped me.’ The patient after that conversation was like a new person, open to more conversations, happier and overall seemed to have more energy,” Dueland said.
That brings things back to Bolin, who has an interesting take on this. His wife, Kristin, is a former fiction writer who is now a physician’s assistant in psychiatry. They each saw instances where clinicians had a hard time communicating tough news to their patients and their families.
Several years back, Bolin created an English course, “Clinical Encounters” (English 206/207). The year-long creative writing course allowed students weekly patient interactions at the CentraCare Kidney Dialysis Unit. Hoff, Dueland and Miner all took that course during the 2019-20 school year.
Through Bolin’s students’ work in the Kidney Dialysis Unit, Julie Strelow, associate professor and chair of the nursing department at CSB/SJU, came to know Bolin. When Michira reached out about getting CSB and SJU students to work in HELP, Strelow saw an opportunity for collaboration. At the same time, Bolin was developing a new class called “Introduction to Narrative Practice” (English 111), which is being piloted for the first time this spring semester (B block).
During a meeting, it became clear to all parties that this opportunity could be paired with the new Narrative Practice course, expose Nursing students to patient contact hours during their first year and benefitting admitted patients at St. Cloud Hospital.
“This was one of the most productive and fruitful meetings of my career. I think Julie, Evalyn and I saw how all of the pieces — the Narrative Practice course, the Nursing Department’s desire to give first-years as much clinical experience as possible, and Evalyn’s desire to create a robust program — could fit together and benefit students and patients,” Bolin said.
“It (the class) is basically looking at all the different ways in which future clinicians can use narrative, the skills of creative writing and close reading, to benefit their future clinical practices,” Bolin said. “A huge part of that is the ability to actually practice these creative writing skills with clinical populations.”
The semester-long creative writing course will explore identity, during which students can have interactions either in-person or remotely with patients admitted to the hospital.
Bolin created a series of creative writing, poetry and fiction exercises that students can do with interested patient partners.
“The questions that sort of activate someone’s ability to write creatively … really led to some great and helpful conversation and some socially stimulating conversations,” Bolin said.
“Chris Bolin has been instrumental in developing the Narrative Practice class at CSB/SJU,” Strelow said. “He collaborated with CentraCare to build the foundation for the experiences that students have with clients at St. Cloud Hospital as part of their class. One of the specific skills that nursing students hone while learning the art of narrative practice in Chris Bolin’s class is active listening.
“Active listening creates a window into the client’s world, and it can provide clues to understanding the client within the context of their life. The nursing students can take this skill and translate it into their professional practice,” Strelow said.
“Nurses strive to offer client centered care that supports interventions focused on the specific needs of the client. In order to provide this client centered care, the nurse needs to understand the ‘story’ of their client; not just identify problems and treat symptoms. The concept of ‘Narrative Practice’ supports a holistic approach to help healthcare teams truly understand the client and achieve client-centered care,” Strelow said.
The students originally began their volunteer work in Surgical Units One and Two at the hospital. This semester, that work has been expanded into the Oncology Unit.
“Prospective students are interested in learning about clinical opportunities which they can access through their colleges – and there are fewer and fewer of these available,” Bolin said. “This program promises to provide students with on-site and remote clinical opportunities.”
It also provides a great opportunity for younger students to see if a health career fits them.
“It is my goal to attend medical school and become a licensed physician. This program has shown me the importance of being a thoughtful and sensitive conversationalist with my future patients while also giving me the skills to do just that,” Hoff said. “I am dedicated to putting patient interaction at the forefront of my future medical practice. The HELP program has given me the ability to build strong connections with patients in the limited time that we have together. Everyone has a story to tell, and I am grateful that I have the opportunity to hear theirs.”
“I am proud that I can encourage these patients to reach maximum potential,” Dueland said. “I will take the skills I have learned from these programs as I further my education in an occupational therapy (OT) program and as I become a practicing OT. Specifically, since the HELP program has been mostly remote, I have learned that meaningful interactions can occur remotely via telehealth and ensure my patients gain those same experiences.”
“I truly look forward to the time I get to spend with these patients as they are all special and have such unique stories,” said Lily Miner, a CSB junior from Minneapolis. “I am now more able to adapt quickly to different situations that come up with patients. I feel as though I have grown to be a much more empathetic listener and conversationalist, which has been a great skill that I will always use in any aspect of life.
“Honestly, I wish I would have had this experience as a student going to college,” Michira said. “It’s a wonderful experience for students because you actually do see an opportunity to interact with the patient.
“It is a wonderful way for students to learn on how to communicate with patients, because it’s different. You need to be able to know what is appropriate, what is not appropriate, how can I talk to a patient. This is wonderful, especially in this day and era where our young students are so engaged in everything electronic. Having a true conversation with a human being is actually a skill we need to teach nowadays.
“I think it’s quite beneficial for students in that aspect. They will be getting a lot back. I think that’s one benefit, especially for those getting into the medical or nursing field, this will really help them be more confident in a hospital setting, and being confident in interacting with patients,” Michira said.