Nov 18, 2022
Health equity and caring for people with intellectual disabilities.
Episode Introduction
In this episode, Jim Cagliostro, VIE Healthcare’s Clinical Operations Performance Improvement Expert, interviewed Nate Myers to discuss his experience serving adults with autism. Topics include the motivation behind Nate’s move to Keystone, the goal to provide health equity for people with autism, the growing demand for medical experts and advocates in the field, and the ‘’Platinum Rule’’ of Keystone Human Services.
Show Topics
- Working towards healing and wellness by focusing on strengths
- ‘’We grow the most when we’re stretched’’
- Providing community support to adults living with autism
- Leadership begins with having a passion for your work
- Achieving a certification in developmental disabilities nursing
- Striving for health equity for people with autism or disabilities
- The need for more experts and advocates in the medical field
- The ‘’Platinum Rule’’ of Keystone Human Services
03:08 Working towards healing and wellness by focusing on strengths
Nate said his decision to become a nurse was influenced by understanding that everyone deserves positive relationships and experiences.
‘’I'm pretty patient, I'm good at keeping a positive regard and encouraging others, so it just seemed to work. And I quickly developed an understanding and appreciation that every person desires and deserves everything good in life, to be understood, to be appreciated, to be independent as possible, do things that they enjoy, have positive relationships and be healthy. So that's the same for people with intellectual disabilities or autism. Of course, they want those things just like everyone else does. And so I learned a lot about what it means to be a human, and deciding to become a nurse was kind of just an extension of what it means to care for someone who's in a vulnerable position for sure but also working towards healing and wellness and focusing on strengths and not weaknesses. So all that kind of came together in my decision to be a nurse. And actually, when I told my wife, "I think I want to go to nursing school," she was like, "Yes, that's perfect. Go for it." So she was always an encourager for me and rooted me through a lot of the difficult aspects of becoming a nurse.’’
07:49 ‘’We grow the most when we’re stretched’’
Nate said that asking lots of questions helped him to develop a keen understanding of the nursing basics.
‘’I think that's really important when you're in nursing is to challenge yourself. And I remember, going back to that encouragement from my wife, I remember when I started in the ICU, I felt so new and like I was in over my head. And my wife reminded me, we often grow the most when we're stretched, when we feel stretched. And so I've remembered that. I've taught that to other people. And I just remember every time I face a challenge that I'm stretching and I'm growing at the same time. So I think that's important to remember on anyone's journey. But in all those settings, I developed kind of a keen understanding of all the basics of nursing: physical assessment, clinical skills, differential diagnoses, how to do patient education, just working with people. And I always ask questions of all the physicians. Probably people got tired of me asking tons of questions.’’
09:36: Providing community support to adults living with autism
Nate explained how his nursing background helps to provide medical care in the community for individuals with more complex needs.
‘’The majority of our participants actually live in home and community setting, meaning they're living independently or with a roommate or with family, with their parents. We do also have some care dependent individuals. They receive 24/7 support just based on their support needs. And I was kind of pulled in, I think, primarily because some of those medically complex folks, they just needed a nurse to join the multidisciplinary team to assist all the staff and the leadership in what to do with those individuals. So yeah, so that's a little about my experience. And I really feel like the role that I'm in now really blends some of those skills with just my personality and all my interests in a unique way. And I think at the very heart of nursing as a profession is a desire to optimize health and wellness for each patient. So I feel lucky because I get that opportunity to work as part of this multidisciplinary team, all these different disciplines. And in the community setting, I get to join the rest of the team to work on these person-centered strategies to overcome barriers and improve health and wellness. And it's exciting because everyone's different.’’
14:11 Leadership begins with having a passion for your work
Nate said leaders must create culture and inspire excellence in everything they do.
‘’I think leadership has to start with having a passion for the work that you're doing. It's so important to have a sense of purpose or mission so that that is your compass. I feel like if you don't have a compass to guide and direct your responses and your actions, it's really difficult to educate, support and lead others if you don't have that compass driving you. So leaders create culture, and I think it's important to inspire excellence in everything that we do. I think leaders should be prepared as much as possible, pay close attention to the details while also remembering that bigger picture.’’
16:51 Gaining a certification in developmental disabilities nursing
Nate explained that gaining certification came out of a desire to support the team at Keystone Autism Services.
‘’Right. And the experience definitely weaves itself into leadership. You can lead others without a lot of experience for sure, but after being a nurse for over 10 years, you want to pass on what you've learned to others. And so getting that certification in developmental disabilities nursing really came out of a desire to be a leader in the field, but also to help really support the team at KAS as best as I can. So yeah, experience definitely, like I said, weaves itself into leadership kind of naturally….Because again, I had this kind of underlying passion for this population. So I've always kind of been interested in it, but again, you have to really be in a specific role serving the population for a certain amount of hours to achieve it. So it was kind of always unattainable before. Definitely not mandated, but if you're interested in pursuing a specific population or a specific set of skills, I think if you're driven and you have that level of interest and you want that experience, getting that certification is just kind of a solidification of that mindset, I think.’’
19:43 Striving for health equity for people with autism or disabilities
Nate outlined the services KAS offers to the local community.
‘’And so for KAS, services are catered to each individual so it's very person-centered. It includes coordinating care for healthcare and therapy, various behavioral supports, family supports. We have a lot of emphasis on vocational and educational support for each individual and just enhancing wellness in general. And so the way I fit into that from a health perspective, we're always striving for health equity in the population we support. So for the most part, all the recommended health related screenings for the general population based on age are going to be the exact same for individuals with autism or disabilities. So get all that as a baseline. So make sure that they're getting those routine screenings: annual physical, dental exam, reviewing their medication appropriately. And then beyond that, when you talk about health equity, it's identifying barriers that exist for individuals with disabilities and then enhancing supports to overcome those barriers. So we help identify specialists that address unique needs.’’
21:22 The need for more experts and advocates in the medical field
Nate observed that the prevalence of autism has increased, but individuals are not always getting the routine, preventative care they need.
‘’And so my goal when I'm teaching is to create a context in which we can meet the patient where they're at and modify care appropriately to create positive outcomes. I mean, I feel like it's really important for anyone that works in healthcare to know about. The prevalence of autism has only gone up in the last 20 years. We've seen it. CDC has a autism and developmental disabilities monitoring network, and in 2000 it was one in 150 8-year old children had an ASD diagnosis. Now the most recent is one in 44. So those kids are going to age out of the school system where there's a lot more coordinated and kind of concrete support into adulthood where there's a big gap and a big need for support. So that's the population that we support, both vocationally and from a health and just life span perspective. So we need more experts and advocates in the medical field who have a deeper understanding for ASD, autism, and in general, intellectual and developmental disabilities. People are living longer lives and they often miss out on routine preventative care. Other issues like challenging behaviors can be treated with psychotropic medication or the accumulation of more meds than they need, but it could be just underlying illnesses that are missed, like GERD or gut sensitivities, things like that. And even in COVID, if your listeners are interested in learning more, the National Council on Disability put out a detailed report called The Impact of COVID-19 on the People with Disabilities.‘’
26:08 The Platinum Rule at Keystone Human Services
Nate said Keystone advocate for the Platinum Rule in the way they treat people.
‘’And then I'll finish up by saying something that impacted me during my new employee orientation here at Keystone Human Services. I'm sure you've heard of the Golden Rule, treat others the way you want to be treated, but they advocate for what they call the Platinum Rule, which I thought was really cool. And it's treat others the way they would want to be treated. So it really implies getting to know the person, listening to them, understanding the other person and their needs, and again, remembering every person wants to be understood, to feel comfortable and regulated, be as healthy as possible, and to be treated with dignity and respect. So let's be kind to each other, right?’’
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You’ll Also Hear:
From Best Buddies at the Special Olympics to a summer job at Keystone Human Services at college; Nate’s early experience of working with people with disabilities, at a time when autism services didn’t exist.
Changing your perspective, the life lessons learned from vulnerable people: ‘’What you can learn from them is much more than what you can do for them…. Realizing that everyone has vulnerabilities and needs… we’re all the same in that way.’’
How a relationship-based approach to nursing care enables Nate to support people in the community over a longer period compared to an acute care setting.
Coping with surprises: Why Nate’s experience hasn’t always been easy ‘’…but again, nothing worth doing is going to be easy….I’ll keep improving and that’s ultimately the goal.’’
‘’Filling in the gaps to create a richer sound.’’ How Nate’s musical background influences his leadership style in the nursing community.
Discover the mission behind Keystone Autism Services: ‘’Identify and reduce barriers to all those good things in life that everyone wants … provide the support that people need to live their best life.’’
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