2018 AMRI Scholarship Program by Yolanda R Cockerham

Author: Yolanda R Cockerham

School: Southeastern Louisiana University-Post 

Area of Study: Masters Psychiatric Nurse Practitioner 

Introduction

While spending every summer on my grandparents' small farm, I began to develop a curiosity with the science behind how plants grow and develop, and how the body works. When I was five years old my mom became a single parent after my dad died of heart disease, so she worked two jobs over the summer months. During my summers, I remember conducting all kinds of experiments on myself like pushing a butterbean up my nostril to see if it would fit in between my turbinate, and placing a field pea into my ear canal to see if it would easily roll out. Of course, my grandmother and I had quite a few visits to the local emergency room. I collected many earthworms, tadpoles, and turtles to study how they lived in their environment. I observed many different species of birds and read up about them inside the encyclopedias that my grandparents had, since there was only one television in the home. To this day, I still find myself birdwatching.

A Growing Love for Science

I was definitely intrigued by science, and became obsessed with a microscope when I was about nine years old. There was a really old model microscope at my elementary school, and we were able to take turns viewing different objects, like dead leaves or fabric, on different power levels. Microscopic viewing was always so much better. By the time I started middle and high school, there were enough microscopes at school to go around. I spent so many extra hours doing projects just so I could be close to the microscope, especially when it was time to view tissues from dissected frogs and guinea pigs. Throughout my high school years, my extra money came from caring for infants and toddlers in the form of babysitting. I learned how to perform basic activities of daily living as well as providing a secure and comforting environment for them. It was something at which I became very good. Merging my love for science and caring for people originally led me to a pre-medicine major.

Attending Tulane University for college started as a desperate attempt to be normal. In other words, I was not only surrounded by kids who were as smart, but some were 10 times as smart as I was in biology. I struggled to stay on top and measure up to the late professor Ellgaard who challenged every aspect of his genetics class, and professor Ide, who made neurology a household name for me.  The immaculate sulci of the brain with its occasional overgrowing senile neurotic plaques and bundles have found a way into the genetics of my family’s DNA. Recently my grandmother’s brain has been overtaken by the last stages of Alzheimer’s disease, just as her two sisters were, in their late eighties. Out-of-whack neurotransmitters and hormones have also affected my late uncle and brother with schizophrenia.

From Laboratory Research to Nursing Research

For nearly eight years after college, I indulged in the area of research. I did laboratory research with what was known as Michigan Cancer Foundation-seven (MCF-7) breast cancer cells and how melatonin affects them. I assisted the Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group with various human immunodeficiency (HIV) clinical protocols at my designated site, which has helped to define some current treatment models in HIV. I also participated in quite a few significant clinical research protocols in erectile dysfunction and Peyronie’s Disease. It was during this time that I decided on a career in nursing research. I knew a career in nursing would offer such diverse avenues that mingled science and people.

Right before Hurricane Katrina, I was persuaded by an advanced practice nurse practitioner (APNP), who was certified in urology, to pursue a career as an APNP to give me more autonomy in my research field. The first week of online class was disrupted by a hurricane evacuation. Post Katrina access to New Orleans was a challenging time for all of us including a two hour daily commute for work and school, since some parts of the city was uninhabitable. Many of my clinical sites were in a nearby city, where I also started employment as a clinical nursing instructor. It is always important to spend time contributing to the education of future nursing students, since it allows me to play a part in evolving my own profession.

Using ACLS Skills to Save Lives

Advanced cardiac life support (ACLS) has certainly been a very valuable asset to me during my clinical instruction. I remember quizzing a student in the hallway, after her initial assessment of a patient who was a nearly seventy, and post cardiac surgery. As we re-entered the patient’s room, he was not responsive. I initiated chest compressions, and had the student to call for the cardiac team. Everything happened so fast, but I remember I was in the bed straddling the patient, because he was nearly three hundred pounds, and six feet, and it was very difficult to perform the compressions. The team was able to revive him and it was an awesome pleasure to participate in this scary event.

Every aspect of ACLS is important for utilization, and has been used in numerous aspects of my career. I am currently working in a pediatric clinic. Last year while doing an exam on a patient, who was having some difficulty breathing due to croupy cough, the use of back thrusts and a downward head tilt, assisted with vomiting mucous. Although this patient never lost consciousness, I was able to help improve his breathing, but placed him on oxygen, along with a rescue nebulizer medication.  There is always an increased risk for shortness of breath in the pediatric population, particularly in those with a family history of Asthma, and have parents who expose them the smoke.

Working as a Nurse Practitioner

On my road to becoming a nurse practitioner (NP), I automatically ruled out pediatrics as an optional population because I thought of them as being too fragile. Not to mention, I did not want to deal with the parents, and was solely focused on urology research as my outcome (or so I thought). However, I took the advice of a seasoned NP who taught me that “children are just short people,” and one of my late NP professors, Dr. Anderson.  She told me that just becoming an adult NP versus a family NP would “limit my versatility for employment,” and I would regret it later. I took their advice and then was able to imagine that I could take care of them, and became more relaxed in treating this population, once I gained the trust of their parents. Now I am unable to imagine my life without pediatrics.

Although I still have close ties with my urology community, I have not returned to either lab or clinical urology research. I am not sure why, since there have been so many leaps and bounds in the previous area I was studying. I have toyed with returning to the lab sometime in the future, but I have found myself too clinically absorbed with taking care of the medical and physical needs of the patient. I think this is the beauty of the medical profession. There are so many different areas that could be explored, and there is no room for boredom.

A few years ago, after becoming a nurse practitioner, I provided in-home primary care for homebound home-limited adult patients. Of the one hundred and twenty patients, I had eighty who had a mental health diagnosis of schizophrenia, post-traumatic stress disorder, addiction or bipolar disorder. These patients often were distanced from their family and lived in different group home settings and often taken for advantage by their landlords.  This left my heart very unsettled, and currently has prompted me to pursue a post master’s psychiatric nurse practitioner (PNP) certificate at Southeastern University in Louisiana. Becoming a PNP will increase my scope of practice as a family nurse practitioner and help me to decrease the mental health disparity in my community.

There were really so many factors that helped to initiate my interest in the medical field. From my grandparents farm, my obsession with the microscope, my grandmother’s Alzheimer’s, to my relatives’ schizophrenia; all have provided continued motivational factors in choosing medicine as a career path.  I take great pride in the fact that I do not know everything, but I take great pleasure in researching the answers.

A Bright Future: Where I See Myself in 5, 10, and 15 Years

In the next five years, I would hope to help my daughter prepare for college graduation, and secure a master’s level spot at a university. I hope that I have influenced her decision to join the ranks of research, because she is thinking on a career in forensics. Since she has multiple avenues to explore, she is leaning towards law school or psychology, medical lab technology, or nursing.  I would like to assist my son in purchasing his first home if he ever finds a city interesting enough to lay down his roots, while he continues to travel in the film industry.

During this time, I see myself starting out small as a PNP, with just a few pediatric patients and interpersonal behavior therapy as one of my main therapies. I would hope that I will become comfortable with performing psychotherapy on these patients, before moving on to a larger population. I know that the psychotherapy part of the psychiatric program will take multiple years to perfect, and always have room for flexibility and growth. Rejoining my research friends in urology may also be another option for me at this time. I would either offer my lab help with a new clinical project or my psychotherapy services to those male patients, as they struggle in their current relationships while dealing with erectile dysfunction or prostate cancer diagnosis. Tying urology to my current practice would be phenomenal to me.

Over the next ten years as a PNP I would like to: assist Louisiana in increasing access to chronic mental health services; serve as an agent of change in diagnosing and managing chronic mental health conditions in the outpatient setting; and assist adult patients in securing a safe stable home environment as they continue to heal post mental health discharge.  

My suggestions to the problems in Louisiana include offering helpful services or resources with long-term solutions. For most patients, seeking addiction treatment for substances may only be initiated as a way to please family members, or as a professional job requirement. Until a patient hits rock bottom, or runs out of resources, will they be able to find a real/right reason to seek help. This can be done by using a coordinated continuum of care between primary care, social services, mental health and addictive disorder counseling, as well as, clean safe housing environments. If patients are not enrolling (or seeking help) into programs for the right reasons, they can anticipate relapses in six months or less.  

Primary care would provide yearly preventative screenings like mammograms, or immunizations. Mental health counseling would include weekly peer relapse prevention groups or having twenty-four hour staff available if a patient needs an intervention when they feel like they want to use, because they just saw a piece of crack cocaine on the ground.  Social services would include the availability of a case manager seven days a week to help with community outreach, like finding good transitional housing, once discharged from their hospital programs. Usually patients with both addictive and mental health disorders lack the ability to make good cognitive decisions.

In fifteen years, I would hope to operate an independent thriving mental health practice and continue to hone in my skills and gaining tighter control of our mental health population. This would include certifications for various therapies like family counseling, and for children art and play therapy, dialectical behavior therapy, and eye movement desensitization and reprocessing for post trauma care. I also want to be equipped with an additional PNP, at least two in house social workers, along with various outreach workers at local public schools to minimize transportation concerns for parents and students who struggle to make counseling appointments.

This essay was a bit of a challenge to write, since I have not previously chronicled my career or education in this manner. I do love the areas I have chosen. Thank you for the opportunity.