Dr. Gloria McNeal, Dean of the School of Health and Human Services at National University. A nurse whose role is to oversee three departments. Department of Nursing, Department of Community Health, Department of Health Sciences. This includes 4100 students, 300 faculty and 17 programs from Baccalaureate to Masters and soon a Doctor of Nursing Anesthesia Practice.
Dr. McNeil Talks Person Centered Care
What we have done is embedded person-centered principles into all of our curriculum of study and in addition to help the students really get hands-on experience, we have developed a nurse led clinic. There are five of them in the Watts community in Los Angeles, South Los Angeles. Our students can both virtually and on-site deliver primary care services to the patients that we serve. We currently have been in operation for three years. We have 600 patients in our caseload and we are bringing primary care services to a community that pretty much has limited access to care. So, our students learn firsthand person-centeredness and how to address the needs of patients who typically have been disenfranchised.
Cultural Competency: Effective Care Delivery Among Diverse Populations
Many of the patients in our South LA area are Spanish-speaking, in the 60s or so was mostly African-American demographically, now it is mostly Latino and Hispanic. So we have ensured that our clinicians are bilingual that they can speak Spanish as well as English and assist in translation and interfacing with the community. By putting individuals in this community who look like, talk like them, it makes it more receptive.
The other thing we've done is most grants will not support capital expenditures, so we couldn't build the clinic, so what we did is we embedded ourselves inside of churches, Salvation Army locations and drug rehabilitation centers so we've gone to each of the CEOs of these entities and asked if there was space, they gave us a room and we converted the room into a clinic and that's how we see our patients. We are where they live, we are in their community, we are at their place of worship, so they can trust us because we're in a facility that they recognize and that they go to. They go to the Salvation Army, they go to the drug rehabilitation centers, and they go to church.
Track Record of Working with Telemedicine in Underserved Populations
In the early 1990s this nation was hit with a horrible measles epidemic that killed 167 children and put 3,000 others in intensive care units unnecessarily, these children were not being properly immunized. The Clinton administration put out a call for a summer of service initiative and requested that we identify a problem within a city that we wanted to address. The caveat was that it had to include students in high school, in college and so forth. So, working with the Department of Health in the city of Philadelphia, we identified the immunization rates were horrific, so we put a summer of service together to immunize children ages 0 to 5.
There were eight schools of Nursing involved, at the time I was associated with Thomas Jefferson University and we were one of the mobile entities, so we put an old bookmobile into service gutted it, turned it into a clinic and traveled around this immunizing children and putting the children into the database within the Department of Public Health to finish their vaccine schedule. We did that for a while and I thought to myself, you know what, if we can do this for immunization, what about if we did it for full-scale primary care services.
I became the director of the emergency care mobile healthcare project. I had four mobile units, we traveled around Philadelphia and the surrounding counties delivering primary care services. This was a nurse led model, all of the nurses aboard the vehicle were advanced practice nurses. We did that for a few years and then I had opportunity to come out to California, I was recruited to National University, and at that time I thought, you know what, the mobile vehicle is nice, but it doesn't have all of the trust and support, it's not deeply embedded into the community. So, with this model I elected not to use a mobile unit but to make the health care clinicians mobile.
The team moves from place to place, the five locations where we're located and we added one more piece, telehealth technology, so now we're able to monitor the patients remotely. If we want to know what someone's blood pressure is doing, what their weight is doing, what their oxygen is doing, we could get all of that information. They don't have to leave their community and that information is transmitted to the cloud and we download it and put it into our medical record. So, that's the piece that I think is innovative, it's a mobile healthcare team, it’s using telehealth and it's embedded deep within the community.
Cost Effective Ways of Combating Resource Limitation to Serve High Need Populations
I found a startup company that was interested in showcasing their products, for a fraction of the cost, because telehealth technology is very expensive. So for a fraction of the cost we were able to purchase five units that included the blood pressure of the pulse oxygenation, blood glucose monitoring, body weight, heart sounds, lung sounds, and a 12-lead EKG package we could put in each of our locations. The individuals simply had to go to a place where they normally go anyway and we could monitor their vital signs. We don't yet have the capability of putting the equipment in the home and that will be our next iteration when we have more funding. I do believe that to improve access health care will be delivered in cyberspace in the future and at that point everyone will have an opportunity to experience great health.
Foster Change by Incorporating Young People in Decision Making Processes
Young people, just by definition of being young, they're very visionary and they want to make change, they really do. All you have to do is give them the avenue, so when I set up these mobile units and all of that and made it available to the young people, they were right there, I didn't have to coach them or anything. They wanted to be where the action was and they wanted to make a difference. So even now with my nurse managed clinic, I can't hold the students back, I don't have room for all of them, because it's 4,100 people. They gravitated to it naturally and they come up with amazing ideas about how to change the system. Ideas I had not thought about because of their youth and their interest in changing the world, it's just a natural entity that they have.
If You Weren't In This Career What Would You Be Doing Instead?
I always wanted to be in healthcare, I never had an interest in any other career, not that I was not exposed to the other careers. I saw them, but I didn't see them making the commitment to underserved populations and really helping people develop their health because health is everything. If you don't have your health, it's very difficult to exist. The other disciplines weren't oriented in that direction.
Who Has Impacted your Professional Journey?
Early on, I was guided by my mother, she was a single parent and we lived in an underserved environment community, she was a very visionary woman. She wanted her children to go to college, she herself did not have skills but I watched her develop an affinity for Nursing and so she started out and as a nursing assistant. She was so interested in advancing her skills, she was able to at that, apply for a waiver license for vocational nurses and there was an exam, an interview. She passed when she became a licensed vocational nurse and so I watched her manage patients, and the love that she had for the profession. She wanted me to be a nurse and so I was able to, with her guidance.
She worked three jobs to put us through school and I was able to successfully graduate from the Villanova University with my undergraduate degree. I was interested in assisting her in paying for the tuition and so forth so I joined the Navy. The military paid for my education, my last two years I was a commissioned officer. When I left Villanova and I was stationed at Philadelphia Naval Hospital where I was promoted two more times to a lieutenant and gained critical care experience. From there when I transition to the civilian world.
I wanted to continue my education so I acquired a master's degree in nursing at the University of Pennsylvania and continue to work in critical care areas as a supervisor, but I also always liked teaching students. So, I went back to the University of Pennsylvania to acquire a PhD in higher education administration. I knew I'd be a Dean or something, so that's my educational background. Of course being at those institutions gave me some forward-thinking and visionary approaches to what I do now.
Legacy in Health Care
I like my legacy to be, recognizing what it takes to address the healthcare needs of underserved populations and to be where the person is, to not impose and to recognize that we're all different and we have different ways of living and experiencing life. Not to be judgmental, to try to be where the person is to address their health care needs. If I can imbue that understanding in my students as they go out into the world, I think I will have left a legacy.
This interview was recorded at #Planetree18