2018 REHPS Azra Osmancevic

Final Thoughts:

Prior to beginning my journey at Fall River Health Services, I had never been exposed to a healthcare experience in a rural community. Spending a month in Hot Springs was eye-opening because I received the opportunity to work with and shadow a variety of individuals from different backgrounds and disciplines. Each person that I met throughout this experience has left a lasting impression on me and has taught me important things that I will use in my future clinical and research work as a Clinical Psychologist. One of the most significant lessons that I learned from each individual during my REHPS experience was the importance of community. Community to the Fall River Health Services team means more than just the patients that you serve or the individuals that you work with; community to this organization means the importance of working, growing, and succeeding as a team with both your patients and colleagues. It was refreshing to see this played out in each day of my REHPS experience because it underscored the importance of teamwork and community togetherness in everything that we do as healthcare professionals. I know that I will encounter a variety of individuals in my future work, and my time spent at Fall River Health Services has better prepared me for this important undertaking. During my experience I was not only welcomed by each person that I met at FRHS, but I became a part of their community and I am honored and lucky to have experienced that.

Week 1:

My experience thus far in the REHPS program at Fall River Health Services in Hot Springs, South Dakota has been an exciting and eye-opening week in regards to different areas of rural healthcare. Throughout this past week I have received the opportunity to shadow healthcare professionals from not only my field of interest, mental health, but a vast amount of individuals from different areas and backgrounds as well. In our first four days of the program, our program coordinator had us meet with every department in the hospital in order learn more about what their roles are at Fall River Health Services and to gain insight about what their biggest challenges are in regards to serving and providing healthcare services in a rural community. I appreciated this because I got to see the similarities and differences between various departments and staff. Most importantly, with each meeting throughout the week I saw more and more how important the community was to each individual I met. Each person and team displayed genuine interest and care for their community members, coworkers, patients, and town. In addition to this, I saw an extreme sense of pride displayed by each individual for their hospital and the work that they all do. Not only is Fall River Health Services a critical care, non-profit organization that provides culturally responsive and appropriate care to all of the community members in Hot Springs and surrounding rural areas, but it is also a home that considers each worker, patient, community member, and visitor as a family member. As I wrapped up my first week of new experiences at the hospital, I too felt as if I was a part of this strong and proud family.

My first week of the REHPS program was filled with numerous new experiences and many firsts. These first experiences include shadowing the head of the Ultrasound Department, learning from him, and performing my own ultrasound on my REHPS partner, Scott, shadowing various healthcare professionals in the Emergency Room, attending and participating in rounds at Pine Hills Retirement Community and the State Veterans Home, learning about various medications and how to make an IV bag in the Pharmacy department, and shadowing Dr. Wilson, the FRHS psychiatrist, during his therapy sessions with several patients. I never thought that I would be completing rounds with doctors and other healthcare professionals or carrying out my own ultrasound all by myself! Each healthcare professional was so excited and receptive to my questions and with providing help in areas that I needed. In addition, they all tried to connect each activity that we were doing back to my own future profession, Clinical Psychology. I appreciated this because I felt as if I was providing my own expertise to the experience and saw how important interdisciplinary work is in this rural healthcare environment. For example, Brenda, the registered Nurse Practitioner that welcomed us to joining her on rounds at the State Veterans Home, gave each of us a task after our rounds that focused on a specific patient in our respective fields of interest. My task was to learn more about and share my thoughts on the rebound effects, specifically rebound anxiety, which patients suffer from due to benzodiazepines. This experience was great because it not only made me put my own current knowledge to the test, but also allowed me to learn more about the effects of certain medications with respect to a patient’s emotional, behavioral, physical, and brain functioning and wellbeing.

Two additional encounters this week specifically stood out to me in regards to providing healthcare services in a rural setting. My meeting with FRHS Speech Pathologist, Annie, was extremely eye opening and inspiring. Annie discussed the importance of her position at FRHS and the issues she faces in a rural community with her profession; however, one important topic specifically stood out to me. Her words about the importance of the therapeutic relationship and providing culturally responsive care in rural medicine were powerful, and I found several parallels with the field of Clinical Psychology in her discussion as well. In my graduate program we are taught that the therapeutic relationship is of upmost importance during therapy, and I saw this importance as well as I got to know more about Speech Pathology. Annie’s words will always stick with me, specifically this important factor that she mentioned, “In a rural community, your patients do not want to know how many degrees you have, but instead want to know if can you help people.” I believe that this is true with any profession in any setting, but especially with the rural and underserved communities I wish to provide services to in the future. Annie also mentioned this important fact about providing services to rural populations, “Rural community medicine is extremely fulfilling, rewarding, and exhausting, but you must remember to be the human being that you are and then the professional when providing services to underserved populations.” I learned a lot of important information from my visit with her, and I wish to emulate her dedication and genuine care the individuals she serves and for culturally responsive heath care in my future career.

Another important moment from this week was my meeting with the Psychiatrist, Dr. Wilson. I received the opportunity to shadow him twice during my first week at FRHS and have already learned so much from him in regards to the field of Psychiatry and Clinical Psychology. I saw how the two fields intertwine and complement each other in the rural medical setting, and enjoyed being a part of this during my shadowing experiences. Dr. Wilson also shared his experiences with adjusting to providing rural mental healthcare services and living in the same rural community. He mentioned how unusual it was at first to be a mental healthcare provider in such a small town, how patients would drive past his house to see where he lived, and how pictures of his family and himself were in the newspaper when he first moved to town. When he first said this, I was shocked! He laughed at me and mentioned that he was as well, but then learned that this is how patients from rural towns build trust with the providers in their community. He mentioned an extremely important remark about this aspect of his role as a provider in a small, rural town, which included to not push against these types of actions or gestures, but to embrace them in order to avoid being disrespectful to the community and its people. By doing this, you not only showing respect to your future patients and immediately start building rapport in order to establish a strong therapeutic relationship, but you also normalize and reduce the stigma associated with the idea of seeking mental health services. This was important to me because it highlighted the most important factor that we are taught in graduate school: seeking mental health services and experiencing mental health issues is normal. I believe that if I provide services in a rural or underserved area in my future clinical work, that I will be better prepared due to Dr. Wilson’s insightful advice and thoughtful words.

In addition to participating in all of these wonderful experiences during my first week of the REHPS program at Fall River Health Services, my partner, Scott, and I also had a lot of fun outside of the hospital. We explored the town of Hot Springs together and ventured out to various historic and beautiful sites. A list of some of our adventures include, visiting Evan’s Plunge, Cascade Falls, the historic Mammoth Site, Jewel Cave, Custer State Park, and Sylvan Lake, hiking to the top of Black Elk Peak (7,242 feet elevation), and trying the world-famous Black Hills Burger and Bun Company’s burgers! I have thus far enjoyed all of my experiences during REHPS – and this is only the first week! I look forward to learning more from and working with everyone I meet, staff and patients included, in order to strengthen my own knowledge as a future professional in rural healthcare, and to seeing more of the beautiful sites in Western South Dakota.

Week 2:

My second week of my REHPS experience was filled with even more fun than my first week of the program. Monday was filled with some very interesting activities including a non-scheduled psychiatry patient that came into the clinic, an ultrasound done on a MERSA patient with cellulites, and an echocardiogram. I got to shadow the psychiatry nurse practitioner, Tracey Romey, the entire day and learn more about how she conducts psychotherapy and medication management with her patients. I enjoyed shadowing her because I learned more about how psychology, specifically psychotherapy, plays a role with medication management and the importance of determining whether or not a patient is suitable for certain medications. In addition, we also had one of her patients come into the clinic unscheduled; this patient was also suspected of acting in certain ways and saying certain “buzz words” that usually persuade psychiatry providers to prescribe medications. It was interesting to see how Ms. Romey interacted with this patient, specifically how she helped without needing to prescribe any medication right away. I also got to shadow Ed with another ultrasound patient. This specific patient was considered a MERSA patient, so we had to put on special gowns in order to make sure that we did not get exposed to the contagious condition. I enjoyed learning more from Ed and further seeing how much he values patient-centered care.

My Tuesday consisted of mainly spending time with the FRHS psychiatrist, Dr. Wilson. During the day I got to shadow him with a variety of patients, with the youngest patient starting at the age of three to the oldest patient at the age of 102. I am thankful for the amount of exposure I have received thus far from shadowing Dr. Wilson and learning more about how he conducts psychotherapy and medication management with a variety of people from different age groups and backgrounds. In addition to this, I participated in the Psychotropic Medication Administration (PMA) meeting with a team of different healthcare providers. For this meeting, I was tasked to research and learn more about four different patients that are currently on certain psychotropic medications. I specifically looked at their psychiatric evaluation histories and the amount of times a Gradual Dose Reduction (GDR) had been administered to the patients. I enjoyed learning more about the different patients’ backgrounds and needs in regards to psychotropic medication usage and management. Many patients had unique stories and struggles and learning more about the certain medications that they are currently taking painted a better picture of how we as healthcare providers can provide the best patient-centered care for them.

Wednesday consisted of two drastically different activities, both in which I learned a lot from. During the early morning and through the afternoon I shadowed Dr. Wilson at the State Veterans Home during his psychiatric rounds. I enjoyed participating in this activity because it was different from the hospital rounds that I previously shadowed with the other medical doctors. These rounds primarily consisted of talking more with the patients and getting more details about their current life status and medication usage and effectiveness. Dr. Wilson completed a lot of Mini Mental Status Exams (MMSE), with all of his patients and it was interesting to see the variety of answers provided by patients. Many of his patients at the home are currently suffering from dementia and Alzheimer’s disease, so their answers on the questions in which orientation to time and place and questions that focused on memory were drastically different from the norm. I appreciated getting the opportunity to sit in during this time because it showed me how to appropriately relate to patients that are not oriented to their lives like they previously were prior to their mental illnesses. From this experience I learned how important it is to continuously relate to the patients, and how if they do show signs of dementia or Alzheimer’s, to make them comfortable with their thoughts and emotions. In addition to this, I also got to meet with Brain Madigan, the coordinator of the Swingbed unit at FRHS. He described what exactly Swingbed consists of, which is specifically a program that allows patients to stay and receive full care at the hospital for free even though they may be feeling better but are not fully ready to get back to their daily living activities. Prior to my time here at FRHS, I had never heard about Swingbed, but I am happy that such programs exist because it allows for patients to fully recover and ensures a successful future post-hospital recovery and stay.

My Thursday and Friday consisted of two of my weekly highlights. On Thursday I received the opportunity to shadow Dr. Lias during three different surgery operations, including two endoscopies and one colonoscopy. Each operation also included a biopsy and pictures of certain internal body parts to get more information about diagnosis and treatment of certain health conditions. I got to shadow the surgery staff throughout the entire outpatient surgery process (intake, OR, and post-OR). It was great to shadow the doctors and nurses during this time because I got to see how they all worked together to make sure that each of their patients were receiving the best care. I look forward to shadowing these providers again because they showed me the importance of teamwork in the healthcare setting and how each person plays a special role during the surgical process.

My final highlight of the week included meeting with, working with, and learning from Clinical Psychologist, Dr. Parker. This week was our first time working together, and I finally got to see how a clinical psychologist plays a role in rural healthcare. Dr. Parker and I discussed the various strengths and challenges associated with providing care and practicing in a rural community. We also discussed the importance of interdisciplinary work in a rural setting. His words reflected a lot of similar strengths and challenges that several different hospital staff has mentioned to me thus far during my REHPS experience. The main challenge that mental health providers are facing in rural communities is the overreliance on treatments that are a “quick fix” or “the magic pill” to solve patients’ problems. We discussed practical ways to overcome this challenge and how to appropriately talk to clients about the importance of psychotherapy prior to medication usage if not clinically necessary. The main strength of working in rural healthcare that Dr. Parker highlighted several times throughout my shadowing experience with him was the rewarding feeling of impacting patients’ lives in a rural community. Providing treatment and psychotherapy to clients that live in such a small town is extremely different compared to a big city. The therapeutic relationship can become easily changed by the effect of dual relationships. I learned techniques and tips from Dr. Parker associated with managing these relationships while continuously providing patient/client-centered treatment and care during the process as well. I enjoyed learning so much new and helpful information from Dr. Parker this week in regards to clinical psychology in a rural setting, and I look forward to continuing to further my education with him throughout my REHPS experience.
Lastly, I wanted to briefly reflect on my additional activities that I got to enjoy with my REHPS partner outside of the hospital. During this week, I got to celebrate my birthday with the hospital staff (which provided so many delicious cakes for me!) and my partner, participate and walk in the Miss South Dakota pageant parade, visit Cascade Falls, and go to Bear Country, USA, Mount Rushmore, Keystone, and Rapid City, South Dakota. I enjoyed all of these fun experiences so much and enjoyed learning more about the history behind each place that we visited. I look forward to doing more exploring of the western part of South Dakota as I learn more about rural healthcare during the process as well!

Week 3:

My third week of REHPS at Fall River Health Services was filled with so many amazing opportunities ranging from behavioral health opportunities, shadowing nurse practitioners, physician assistants, medical doctors, physical therapy, occupational therapy, and much more. The highlight of my week consisted of meeting with Dr. Wilson’s adolescent and child psychiatry patients.

Before this experience, I have never had any desire to work with children in the field of psychology.  Children can be a very complicated and difficult population to help when it comes to various mental disorders and issues. However, Dr. Wilson showed me how rewarding it can be to help a child or adolescent that has been suffering so much from such a young age. At the end of each of those experiences I felt like I made a special connection with the children/adolescents that mattered to their lives in some way. That may seem somewhat cliché, but it feels good to see positive progression in patients and to realize that you have made a positive impact in their lives. I look forward to helping more children and adolescents in my future clinical work, and I will use much of the important information needed in order to work with this specialized population that Dr. Wilson taught me along the way.

One of the other exciting experiences I received in regards to Clinical Psychology was administering and scoring a personality assessment on a patient under Dr. Parker’s supervision. Prior to this experience, I had not yet learned how to administer this particular personality assessment. This is one of the most important assessments that we learn to administer and score during our second year of graduate school, which I will be completing this fall. Dr. Parker also taught me how to interpret the results and apply them to the psychotherapy sessions. Thanks to Dr. Parker and his wonderful teaching skills, I feel extremely more prepared and ready for my upcoming studies in graduate school. I look forward to applying this new knowledge this upcoming fall and throughout my future clinical and research work.

A few other highlights from this week included attending rounds at both the State Veterans Home and Pine Hills Nursing Home. I found these experiences particularly interesting because I received the opportunity to see the patient-provider relationship in full effect. Each meeting consisted of personalized care in which the provider focused solely on the patient, ways in which to make their stays at each respective facility better, and ways to increase treatment and recovery efficacy. I believe that this will be important in my future work because the therapeutic relationship is something that is critical in Clinical Psychology and learning more ways in which I can improve this is beneficial.

During the weekend we got the opportunity to go boating with Dr. Gardner at Angostura Lake and my partner and I visited Spearfish Canyon, Deadwood, Custer State Park, Needles Highway, Hill City, and the Hot Springs Arts and Crafts festival. Each of these places was so beautiful and filled with so much fun. I cannot believe that my last week of REHPS is coming up and that I have to leave this amazing facility, kind people, and beautiful location. I am thankful for all of the opportunities that I have received thus far, and I look forward to having a productive and exciting last week at Fall River Health Services in Hot Springs, South Dakota.