Penn Nursing Network provides care off campus

In a health care environment characterized by a huge variety of patient needs and a demand for diverse services, the University must train future health care providers on how to best treat patients using limited resources. To accomplish this seemingly impossible task, the School of Nursing sought to establish a holistic approach to patient care and found an answer in the Penn Nursing Network. Encompassing eight practices and a number of other services, PNN fits the needs of a variety of patient types -- from poor urban children to the elderly -- and uses the skills of nurse-practitioners to treat patients who otherwise might not seek medical help. Beyond improving health in the community, PNN also fulfills one of the Nursing School's key missions -- to take advantage of research opportunities in teaching students how to be excellent health care providers. "We have an opportunity not only to serve our local community by providing quality health care to special populations that are really underserved, but also to be able to have the opportunity to develop and test innovative practice models that will likely have implications for public policy for the changes in the health care system that need to happen in the next ten years or so," PNN Director of Academic Nursing Practices Lois Evans said. Unlike a traditional doctor's office, the PNN centers are staffed primarily by nurse-practitioners. According to Evans, patients feel more comfortable around nurses than they do around doctors, and the comfort level affects care. Pilot data from one study indicates that patients are more willing to visit nurse-practitioners, talk to nurses more and require fewer emergency room visits when regularly treated by nurses in a system like PNN. Evans noted that of PNN's operations, two best represent the Nursing School's goals and serve as the "flagship practices" -- the Health Annex and the Collaborative Assessment and Rehabilitation for Elders, or CARE, Program. The Health Annex, located on the grounds of the Francis J. Myers Recreation Center, is actually a collaboration between the Nursing School and the Philadelphia Department of Recreation. The center caters to a primarily low- to middle-income neighborhood, many of whose residents are jobless or can be characterized as "working poor" and lack insurance. The Annex, therefore, encompasses a tremendous outreach program that educates children, parents and the elderly in locations ranging from schools to churches. In an effort to make the center accessible, the Annex was designed to include a community room for meetings and educational programs. Practicing holistic medicine in this community also means addressing ailments and issues that are often not strictly physical. "We kind of blend and blur the boundaries between the mental and the physical so patients can be assessed on both their mental health and their physical health," Health Annex Practice Director Claire Washington said. To this end, the Annex includes a mental health room and a women's room so that patients' needs can be fully addressed and each person can "be part of the team for your treatment? [and] help make the necessary lifestyle changes." The Health Annex also follows through on another major theme of the Nursing School -- focus on prevention instead of simply treatment. "Education and prevention: that is our message in the community," outreach specialist Lorraine Thomas said. And like all Nursing School ventures, the Health Annex offers "a huge role for students," Washington said. Because the center's work is interdisciplinary, students from a variety of specialties have worked at the Annex, demonstrating the Nursing School's emphasis on research, education and practice. Just as the Health Annex uses specialists from a variety of fields to treat patients, the CARE Program offers the elderly "one-stop shopping" for their health care needs. CARE helps older West Philadelphia residents by providing an alternative to a nursing home. With family, occupational, physical and speech therapists, as well as a geropsychiatric nurse and a physician on staff, the program provides a wide range of care. Washington described the CARE philosophy as "looking at the patient as a whole and looking at other factors beside physical characteristics and symptoms" -- much as the Health Annex does. Pointing to research showing that older patients do better in outpatient facilities than in nursing homes, CARE leaders say the program provides an ideal setting for both nursing research and patient treatment. And as part of the Nursing School, CARE involves students in its everyday operations. "For me this has been the best clinical experience that I've gotten," Nursing sophomore Kelly Cornelisse said. PNN programs -- which provided an educational opportunity for 300 undergraduates and graduates last year alone -- have included students from many of the University's schools in an effort to bring together all of the aspects of health care. In addition to the Health Annex and the CARE Program, PNN includes midwifery programs, a continence program, a gerontologic consultation service and community-based health services for women and teens. This fall, PNN will open the Living Independently For Elders facility, serving elderly patients who choose to live in their homes instead of moving to nursing homes. LIFE will be PNN's biggest project thus far, and Evans expects that a second site will open within a few years. PNN signifies the importance of the community to the Nursing School. The two have a symbiotic relationship -- while the school needs the community in order to conduct research and make advances in health care, the surrounding neighborhoods have received better health care tailored to their needs.