Students Lead Home-Based Pulmonary Rehab Program
09/10/2020
The timing was so remarkable, it was almost prophetic.
Dr. Tammy Morrow, JSU assistant professor of nursing, was caring for a family member with pulmonary issues undergoing treatment at UAB Hospital. Part of the care plan included using telehealth as a means to provide lung exercises remotely.
“The telehealth program had a positive impact on my mother’s health while allowing participation from the comfort of her home,” Morrow said. “These factors served as motivation and inspiration for the development of a telehealth program at JSU to serve our surrounding community.”
Dr. Morrow partnered with fellow assistant professor of nursing, Dr. Allison Crabtree, to design Breathe EASIER, a home-based pulmonary rehabilitation program. In addition to serving the community, the program would incorporate interdisciplinary education for students in health care related studies at JSU.
The professors sought funding to launch a pilot through the Big Idea Grant from the LongLeaf Fund of the Community Foundation of Northeast Alabama. The program’s grant funding, awarded in November 2019, occurred just before health care organizations began facing significant impacts related to the global pandemic, COVID-19. Prior to that time, telehealth was used primarily as a matter of convenience rather than necessity.
“When COVID hit,” said Crabtree. “that changed how we looked at pretty much everything.”
Originally planning to launch the program on campus this fall, the team decided to rapidly accelerate implementation of the pilot program to fill a need in the community created by the pandemic. Calling upon faculty and students from throughout the School of Health Professions and Wellness, Breathe EASIER was launched in May in partnership with the area’s largest health care provider, Regional Medical Center in Anniston. With 25 JSU students and three faculty working out of the Tyler Center in Anniston, remote services were provided to eight clients individually for one hour per day.
“The number of clients was only limited by the amount of time we had,” Crabtree said, adding the program ran for eight weeks.
The client referrals originated from RMC’s Cardiopulmonary Rehab Department. Participants ranged in age from 48 to 80 years old and had the primary diagnosis of COPD or other chronic lung conditions. All the clients were at high-risk for contracting COVID-19 and were seeking alternative rehabilitation formats that would allow for social distancing. Participants in the telehealth program used personal laptops, tablets or smartphones to connect and receive care safer at home, thus avoiding unnecessary potential exposure.
After an initial health assessment, clients were remotely supervised and coached in exercise prescriptions catered to their individual needs. These plans incorporated upper and lower limb endurance and strength training using a combination of light weights, Therabands and an arm/leg stationary peddler. Under remote supervision, patients performed respiratory exercises to strengthen diaphragmatic muscles, using a resistive breather device and targeted breathing techniques. Extensive education about disease management and medication adherence were incorporated in the plans of care as were virtual check-ins and ongoing client assessments.
At a time when RMC, in the grip of COVID-19, was forced to shut down several areas, including outpatient cardiopulmonary rehab for six weeks, having a program that was telehealth-based and ready to deploy was incredibly timely, both for clients and JSU students.
“Everything stood still,” Crabtree said. “Our students’ clinical experiences stood still because many agencies barred us from bringing in students. JSU students needed clinical experience, and these clients needed care in a timely and safe manner.”
Students received clinical hours for their participation, which otherwise wouldn’t have been available given that many agencies had canceled clinical rotations due to the pandemic. The interdisciplinary student team was composed of one family nurse practitioner student, nine undergraduate nursing students, seven respiratory therapy students, and eight exercise science students who were supervised by Dr. Morrow, Dr. Crabtree and Dr. Gina Mabrey, head of the Department of Kinesiology.
“Our students have never done anything like this before, working together for this length of time or in clinical rotations incorporating technology used in the emerging field of telehealth,” Crabtree said. “In health care, we so often work in silos, but we must seek opportunities to instruct students in collaborative care. That’s something they’ll need to be able to do once they leave us and enter their respective fields as health care professionals. Through interdisciplinary education, students gain insight and experience in working as a team to improve client outcomes.”
Dr. Mabrey agreed. “No one discipline could have done this project without the other,” she said. “It couldn’t have been as complete and as whole as it was without everyone working together. It was eye-opening all around.”
With the pilot program complete, the team hopes to continue in some capacity. Regardless of what the future holds for this specific program, there is little doubt that the era of COVID-19 has made health care professionals reconsider the way they provide resources to clients.
“I think clients are going to advocate for changes in the way health care is delivered after this,” Crabtree said. “Through the pandemic, we’ve gained experience in the delivery of client care through mechanisms we’ve not considered or widely implemented before. These discoveries have led to favorable client satisfaction and comparable care in a much more convenient and accessible way."
And as the health care industry changes, JSU stands ready to guide its students in adapting to meet the needs of the community. As Morrow said, “When JSU faculty collaborate with community partners, it creates a rich learning environment for students and enhances a client’s quality of life – and that is a Gamecock win!”