My Scope of Practice: Inside HBOT: A Nurse’s Story

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Chimere G. Holmes

What I know is, is that if you do work that you love, and the work fulfills you, the rest will come. - Oprah Winfrey   Megan Benson, RN, BSN, is the Safety Director of a wound care center recognized for superb clinical outcomes and patient satisfaction. Within the past 2 years, she became an hyperbaric oxygen therapy (HBOT) nurse, proud and eager to be a productive member of her Center of Distinction healthcare team.   A 1996 graduate of West Chester University (West Chester, PA), Megan began her career in a skilled nursing facility where she was responsible for nearly 40 patients. A few years (and three babies later), Megan joined one of the med-surg units at The Chester County Hospital (TCCH, West Chester, PA) as well as the orthopedic/med-surg/trauma/telemetry unit at Paoli Hospital (Paoli, PA) and continued to seek new opportunities within the field. When she learned about the HBOT department at TCCH, she took a training program provided by Diversified Clinical Services, Inc., Introduction to HBO and Problem Wound Management for Physicians and Clinicians. By 2009, Megan officially began to practice as a HBOT nurse in TCCH’s wound care center.

  TCCH’s wound center is an outpatient site on the hospital campus; the center has 12 employees, six wound treatment rooms, and one large HBO suite with one Sechrist (Anaheim, CA) chamber. The facility can accommodate a second chamber, hopefully acquired in the near future. Dr. Martye Marshall serves as the center’s Medical Director; Andrew Fazio, Diversified Clinical Services (Jacksonville, FL), manages the center; and Denise Paoline, RN, BSN, CWS, is the clinical leader. Megan’s practice environment and colleagues provide great job satisfaction. “The nurses I work with are a phenomenal group of people,” she says. “They make each work day special. They are extremely competent and efficient and help create a comfortable and warm atmosphere at the center.”   During Megan’s first month of service, the center was presented the Robert A. Warriner, MD Award of Excellence from Diversified Clinical Services. “I had no idea I had been invited to be a part of such an exceptional team,” she says. “I quickly realized there is much work involved in maintaining what they already achieved. I made up my mind early on to work smarter and become a contributing factor to my team’s perpetual success. I wanted to contribute as much as possible.”   In 2010, the center received the “A Center of Distinction” recognition from Diversified, underscoring the qualifications and diligence of the care team. Megan is a humble witness to the care provided every patient and grateful that the center’s efforts have been recognized.   Megan was appointed Safety Director in July 2009. In her current role, Megan is responsible for educating and interacting with patients and maintaining relationships with state and county officials. Some of her daily responsibilities include addressing basic safety issues of the center, staying abreast of codes for the state and county as they pertain to hyperbarics, identifying safety issues in addition to correcting them, participating in monthly inservice training with the entire wound care staff, and educating patients and their loved ones on HBOT and its possible side effects. “I spend 3 hours a day for nearly 2 months with each of my patients,” Megan says. “HBOT is a slow process, but I see how much it changes patient lives. Numerous patients said they thought they had to live with their difficult symptoms and pain. Some were told there was nothing more that could be done for them. When these patients begin to see progress, I am overwhelmingly grateful. It is almost as if each healed wound ignites an epiphany — our patients have hope again.”   For Megan, the most gratifying aspect of her work is seeing anxious, doubtful patients realize that they are healing, regaining limb function, and able to go about their previous activities with decreased pain and fewer troublesome symptoms. “The beauty in every success story is that each patient realizes from the start they have nothing to lose,” she says. “To see that once terrified person share his or her experience with new, frightened patients, telling them how easy the treatments are and to stick with them, is the best.”   One of the more challenging aspects of her job is the vigilance required by both patients and staff regarding safety. “Most of the patients come to the wound care center with many comorbidities and these have to be constantly monitored and their care plan has to be continually adjusted,” she says. “Paradoxically, this is also one of the things I love about the job. You have to use all of your analytical nursing skills knowing that no two days are ever the same.”   Insurance can be an even bigger obstacle. “Medicare and the current insurance programs can create barriers to care,” says Megan. “If a patient has a co-pay for each treatment, 40 treatments later, costs become very daunting. Our management company provides excellent resources that enable us to get the answers we need.” When Megan isn’t working, she cherishes time spent with her husband Jeff and their three children. Her favorite books include To Kill a Mockingbird and The Great Gatsby and she runs to Pink Floyd, Led Zeppelin, and Muse for musical inspiration. Megan also enjoys gardening.   Over the years, nursing has taught Megan that sometimes the simplest approaches provide the best solutions. She knows that HBOT is a valuable, if underestimated, modality. “We treat severe diabetic wounds, radiation damage, osteomyelitis, hypoxic wounds, compartment syndrome, and gas gangrene,” she says. “For these indications, HBOT has been shown to be an effective modality for patients who are otherwise out of options. In this field, you cannot become complacent. HBOT remains somewhat underutilized — I’d like to see more education about this modality throughout the medical community and more funding for research made available.” A team player, HBOT champion, and forward thinker, Megan and her award-winning wound care center personify quality care in her scope of practice. This article was not subject to the Ostomy Wound Management peer-review process.

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