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The Eyes - and Ears and Voice - of Texas: Program allows students to practice public health nursing

Posted: Sept. 26, 2013

Nickie Menefee

Court Ward Visitor Nickie Menefee

They may have physical, emotional or mental issues. They may be children, adolescents or adults. They may come from wealthy or impoverished families and live at home or in a state institution. But one thing that wards of the State of Texas have in common is that they have all been placed under guardianship due to an inability to care for themselves mentally, physically and/or financially.

According to Michael Gianotti, guardianship coordinator with Probate Court No. 1, Texas is home to nearly 20,000 wards. In Travis County, that number is around 1,800 (and growing), and state law requires that each receives an annual visit from a person designated by the court to ensure they are being adequately cared for by their guardian, the court-appointed person or entity — such as a state agency — who makes decisions on their behalf.

“Because wards have effectively been stripped of their rights by the court, it becomes the court’s responsibility to ensure that they are well looked after,” Gianotti said. “They need someone to be their voice.”

Employing a sufficient number of people to visit the wards, however, would be cost-prohibitive, and courts have turned to trained volunteers to meet the need. Initiated by a judge in Galveston County, the Court Ward Visitor Program first enlisted and trained social work and psychology students to assess the quality of care that wards receive. After noting the program’s success, Mary O’Keefe, JD, PhD — both a lawyer and a nurse — felt that student nurses would be a great asset to the initiative and she helped implement the program at universities across the state.

“These are truly our most vulnerable residents, and it’s important that we monitor the quality of their care,” said O’Keefe. “Nursing students, with their innate interest in the well being of others, are a natural fit for this effort.”

A few years ago, O’Keefe introduced the program to faculty at the UT Austin School of Nursing. Carol Gaskamp, PhD, RN, associate professor of clinical nursing, quickly recognized that an interdisciplinary collaboration between nursing and the legal system would benefit her RN to BSN undergraduate public health nursing students and incorporated it into her curricula in fall 2012.

“Once trained, the students essentially become the eyes and the ears of the court,” said Gaskamp. “It’s a valuable experience for them, and many have reported that their eyes were opened to how mentally and physically incapacitated people are treated here in their own backyard.”

After a training session with a guardianship coordinator at the probate court, the student volunteers are sent in pairs to make their visits and then report their findings to the court. As they meet with the ward and guardian, they are responsible for assessing the physical state and living condition of the wards. For instance, they are to note if the ward is clean and uninjured and if his or her needs are being met. They also assess the inside and outside condition of the building where the ward lives in order to identify safety or hygiene problems and note any hazards they find.

“I was happy to report that many of the wards my partner and I visited were very well-cared-for and happy individuals,” said Camille Moore, one of the students in Gaskamp’s inaugural program. “Nevertheless, if necessary, we were ready to support anyone who wasn’t strong enough to speak up for themselves.”

The initiative was expanded to the Alternate-Entry Master of Science in Nursing program and has grown from eight to approximately 40 students. One of those is Nickie Menefee, who recently visited a ward who had some family in the area, but their involvement with him was minimal.

“That realization was heartbreaking,” she said. “But it also revealed how few resources these individuals have and how important it is that we advocate for them.”

As in Menefee’s case, the program provides many students an opportunity to improve their skills as nurses and public health advocates.

“It made me realize how important it is to speak on behalf of vulnerable people, which is what public health nurses are equipped to do,” Menefee said. “We are trained to educate the public about the importance of integrating the medically, developmentally and mentally disabled into the community and to ensure that they are cared for and that their voices are heard.”