Enhancing Palliative Care (With Dr. Sarah Mollman)
Joe Gaccione 0:02
Greetings, you're listening to Vital Views, UNLV School of Nursing Podcast. I'm Joe Gaccione, communications director for the School of Nursing. You might be wondering why a communications guy’s talking to you about nursing. Fair point. I'm not a nurse, but I know plenty of nurses who are willing to share their expertise from all walks of life to help you. My goal is to help facilitate their knowledge to try and make it less in the weeds and more palatable, while retaining the importance of what these health pros are talking about. These nursing stories focus on work on the frontlines, in the classrooms, in the lab, wherever our nurses are making a difference. We're all getting a front row seat to essential health information through the lens of a nurse's vital views. Every so often, we spotlight one of our exceptional alumni to see how they're impacting the world of nursing, whether they chose to stay here in Nevada or elsewhere. Today is one of those days. Here with us in the booth today is UNLV nursing alumna Dr. Sarah Mollman, who is also associate dean of research at South Dakota State University College of Nursing. Last year, Dr. Mollman was named SDSU College of Nursing Researcher of the Year. Her expertise includes end of life and palliative care, oncology, and educational strategies. She graduated with her PhD in Nurse Education from UNLV back in 2018. Dr. Mollman, thanks for coming in.
Sarah Mollman 1:20
Thanks for having me.
Joe Gaccione 1:21
I'm always fascinated by what gets a nurse into nursing. And in your case, you have two distinct reasons for not only becoming a nurse, but a nurse researcher, and both involve your grandparents. Can you share these stories?
Sarah Mollman 1:33
Yes. So when I was a teenager, about 16 years old, I took a CPR class but actually couldn't get certified because I wasn't 18 yet. And it was within a couple months that my brother woke me up, “Do you remember CPR?” and in a rural town, we could get to my grandfather quicker than EMS could. My dad was out on the ranch, he wasn’t going to get there in time. So my brother and I ran over to my grandparents house where my grandfather had fainted in the bathroom. Luckily, it was not a full cardiac arrest, but it was knowing what to do in that situation, who to call, how to help my grandmother, and I decided then that I just wanted to know what to do in those moments and then really tying back into that rural area, which kind of comes back more for my research. I worked oncology for numerous years. And then when I got into research, went more into palliative and end of life care. And that passion has come from that experience as a cancer nurse. And what I saw patients and families go through, but then when my grandmother, so this same pair of grandparents, she had a chronic lymphocytic leukemia, she had heart disease, kidney disease, and then got a serious illness in a rural, that same rural town, which had a critical access hospital, and they decided to air-flight her out. I don't know if she's ever given the choice not to be air-flighted out. So, she, middle of winter, where it was hard for us to get to her, she was 100 miles away from family. And then when she got to that hospital, they did surgery. And I know there, they didn't give her the option of not doing surgery and she was almost 89 years old with those other comorbidities. So, I really want people, and what drives my research is I want people to know that they should have those conversations with their families with their providers. But we should be giving patients that choice of what they want, and that no treatment and quality of life is one of those choices,
Joe Gaccione 3:28
And that has to be difficult in those situations. And I imagine for the professionals too, the health care professionals, whether you're nurses or physicians, you're trying to make the best choice possible, but the way they're looking at it might be different from the way the family is looking at it. Why in those situations, or certain situations, is it difficult for patients to get proper palliative care and symptom management?
Sarah Mollman 3:49
I think a lot of it is time. I think time in our, in our healthcare system is something that's not there. Providers, there's a workforce shortage, providers are reimbursed based on diagnoses, not time, so I think palliative care can really help with that. When you're reimbursed for time and be able to have the conversations with patients about what they want, what their goals of care are, but it also has to come from the patient. We got to make the public comfortable with having those conversations and that's also what I'm working on a little bit now is doing some of that community education and just trying to, so I come from like a German background where you're very stoic and direct and you aren't going to have those conversations but you start kind of just planting those seeds and starting the family to have those conversations so that when it is that emergency, they at least have an idea of what your loved one wants or maybe does not want.
Joe Gaccione 4:41
Now your current role, Associate Dean of Research, that is a recent role, I believe May of this year?
Sarah Mollman 4:46
Yes, May of this year.
Joe Gaccione 4:47
And for those not familiar with that position, what does an associate dean of research do?
Sarah Mollman 4:51
Yeah, so for the College of Nursing, I'm looking at everybody that is in our research track, professorial or clinical track at our university, a tenure track some people call it, where they are expected to do research. I’m there to help guide them, figure out what support they need, make connections for them, try to get infrastructure in place that can help them grow and then the whole College of Nursing grow for its research productivity.
Joe Gaccione 5:17
And South Dakota State University's College of Nursing is a very unique campus because it's not technically one campus. It's split up into four different areas. Correct?
Sarah Mollman 5:25
Correct. So we have our main campus in Brookings, which is on the east side of the state, about 45 miles away is another site in Sioux Falls, then we've got Aberdeen and north central South Dakota, and then I'm actually on the west side of the state in the Black Hills. So, we're talking almost 400 miles apart, some of our different sites. So, the College of Nursing always needs to be thinking about that. And then there's differences based on what site you're at, what you can do for clinicals, what you can do for research, so we have to make all our programs and strategies broad enough where we can implement them at all those different sites.
Joe Gaccione 6:00
Another unique aspect of your work at South Dakota State is that you are actually one of three UNLV nursing PhD alumni who are all working at the School of Nursing, the College of Nursing, in different leadership roles, and none of this was planned, this was all coincidental, correct?
Sarah Mollman 6:14
Yes. So, Dr. Heidi Mennega, I think was the first to come through, you know, UNLV’s PhD program and now she's the associate dean for academic programs. She's on the Brookings site. And then Dr. Christina Plemmons, is at the Rapid City site where I'm at. She's Assistant Dean for Collaborative programs. Her and I used to work together a little bit in the hospital, so I knew she was coming to UNLV Ph.D. program, so I was able to get some of her inside tips about the program when I was deciding on which Ph.D. program. But two of the things that really drew me to UNLV were that my master's in nursing education counted, kind of towards that PhD, so my PhD is a little bit shorter as far as credits, and then the amount of travel. I had young kids at the time and I just didn't want to do two, three week immersions in the summer. So, I think I was able to do the PhD program and come down to Vegas, I think it was five times and that included graduation. So to me, that was a really big draw.
Joe Gaccione 7:09
We've mentioned this before, in a different conversation, but you mentioned as a pre, as a PhD graduate, you said it was okay to become a novice again. When I think of the nursing students, especially the undergrads, there's almost a feeling of, not in every case, but in certain cases, feeling of perfection. You have to be perfect, you reach the point of getting your undergraduate degree and then you feel like you have to know everything, but that's, that's not true at all. You never stop learning.
Sarah Mollman 7:34
Absolutely. If you're in nursing, it's a lifelong learning process. You know, there's, I think it's a saying, “You strive for perfection, so you achieve excellence,” and I agree with that, but I also want people to just realize you're, you're where you're at, you're always going to have something to learn. If you think you know everything, that's actually more dangerous because there's always things we don't know. I was in oncology, I can't walk into an ICU or a cardiac unit and take care of somebody. So, I think we do need to kind of, it's okay to strive for that excellence, but we also want to be in that mindset, where we're always going to be learning, kind of give yourself a break, but also keep learning, don't coast. Once you start taking care of patients, and you see those things, it's easier to learn about them too, I always found,
Joe Gaccione 8:22
Was there a specific moment when you realized that for yourself, or was it more of a gradual feeling?
Sarah Mollman 8:27
It was gradual. So, when I started as a new grad, I was actually in Boise, Idaho on our oncology unit. So, we were doing adolescent chemo on up, doing stem cell transplants, that was huge amount of learning, getting chemo certified, transplant certified. So, that was kind of natural. But then when I moved back to Rapid City, it was different. I had more medical patients, and I realized, “Okay, I know that cancer care well, I need to get back into some of the medical things, some of the liver disease, renal disease, diabetes.” I had to kind of touch up on that because I didn't have as much of that in Boise. So, it can shift when you move, it can shift when you change units. And then once I went into my master's program, doing like Advanced Pathophysiology, I loved it, because I could relate all those patient scenarios to what I was learning, and I think that's what really stimulated that lifelong learning in me.
Joe Gaccione 9:15
Like South Dakota, Nevada has plenty of rural and frontier areas and that changes treatment options for nurses, patient care for nurses. What are the major differences between urban health care and frontier rural health care?
Sarah Mollman 9:29
Oh, absolutely. This is conversations I have when I'm kind of in a meeting with national people that are from smaller states. They don't understand we have patients go on, gets close to 200 miles to get cancer treatment. And how does that look? What can we help them for travel, for the money, for the hotels? And then it is what we need to know in those rural areas? How can we support the staff in those rural areas to do some of that care locally? Because if we're going to help health equity, we really need to be bringing that access to health care to where the patient lives or as close as we can get it. So how can we do that? And that's kind of what my research is looking at, is how can we pull early palliative care into those local areas? My site’s in the middle of the state for this research project, the, the county in which it sits is rural, but the service area really is frontier, and I think the patient that I've talked to that has the greatest distance is about 180 miles and he's going that far to get his cancer treatment. And what kind of burden is that when you're looking at social determinants of health? And, you know, we talk about telehealth and we talk about internet. Well, they don't even, they don't have that. That's not even a possibility. Some are using TracFones with minutes, some are still using a landline. So, while some of those things do help with access, that might not help with every area, so we need to be talking to those people and really figuring out, having them involved in the process of figuring out, how can we improve care where they're at?
Joe Gaccione 10:53
What are some of the reasons that a nurse would get into rural or frontier care specifically?
Sarah Mollman 10:59
Yeah, I think something that we've done at SDSU is integrate rural nursing into our curriculum, so they feel comfortable with it. They feel like they can step into that environment and have the knowledge and skills that they need. We're doing more with primary care and training in that as well, so they can, they can step out and really know what their scope of practice is. So, I think that some of that, then it's, it’s passion for that area, for that hometown. They want to go back there, they want to stay closer to family, you know, maybe a significant other has, you know, their main job is there, I'm thinking kind of those egg people in South Dakota, the ranchers, farmers. Some of them, they just really want that tied to the community, they want that smaller feel to a community and that's something that's really unique, is how that community comes together to help their own. The other great part about that is you see everything, so you don't, you're jack of all trades, you know, it can be OB one minute to the ER to med to surgical, so they get to see a little bit of everything versus specializing just in one area.
Joe Gaccione 12:03
I want to go back to palliative care for a second. As a nurse, you have to have these difficult conversations with family. How do you approach that, that situation? Because I feel like that's almost that's a skill that you can't truly teach in nursing school, like that's almost like an acquired skill.
Sarah Mollman 12:19
Absolutely. I think it's just time. Listening to people role model those good conversations. As a nurse, we've got to think about our scope of practice in what we, you know, we can't diagnose, we can't prognose, but if we've heard the doctor say that, we can ask them, you know, what, what do you know about where you're at? What did the doctor tell you? And you can gain a feeling for where the patient is. But as the nurse, you're also the person that gets to know the patient and family the best. I always worked nights, you know, people think it's boring, but that's actually when people are kind of awake, they're thinking through things, it's quiet, and we can have some of those uninterrupted conversations about what they really want. Where, you know, what were their life goals or what can we do while they're here? So, you know, there's difficult conversations, there's scripting out there, there's apps out there, VitalTalk comes out top of my head, where I think you do have to almost start with a script until you get comfortable with it. It takes practice, so we aren't expecting anybody to graduate and have this skill down. It's something that I think you need to practice, see other people do well, and once you know your patients, you kind of know where they're at and what you can kind of say and not say, too.
Joe Gaccione 13:29
You can't script every potential situation, there's always going to be some type of variable, whether it's the patient or it could be a family member. I've talked to Child Life Specialists before about dealing with a child patient who's not doing so well. You get all different types of family members, and you have to be adaptable and flexible. Some might be incredibly sad, some might be stoic, some might be outraged, all understandable. And when trying to tell a family this is what we probably should be doing with their loved one, you have to be ready to take the proverbial punches.
Sarah Mollman 13:59
Yes, absolutely. And I think something to keep in your head is their reaction is not a personal attack or reflection of you as, as a healthcare provider. They're in a difficult situation and it's really hard to, you know, you have to, I had to just keep reminding myself, “This isn't personal. This isn't about me,” that sometimes you walk into a bad situation, it has to deal with past situations, you're like, “Okay, what can I do today? What can I do this shift to make this shift better for you?” A lot of times, that was simple things. It wasn't anything big, you know. I think it's just opening up and just initiating some of those conversations because patients, it's been shown in research, patients and families are waiting for us to have that conversation and to open the door to have that conversation. And then just, yeah, reminding ourselves that that reaction is based on their circumstances. It's not us as, a as a person.
Joe Gaccione 14:52
Speaking of opening the door, you don't need a doctorate to be a nurse educator, but what did the doctorate do for you, like what doors did that open?
Sarah Mollman 15:01
Oh gosh, yeah. You know, for nurses thinking about what degree do they want, I'll admit starting grad school not knowing exactly what I wanted to do. I knew I didn't want to be a nurse practitioner and then I just remembered my love for teaching, so I got that master's in nursing education, really loved that. But starting the PhD program, I knew that would open the most doors for me upon graduation than other doctoral degrees. So, that's one of the reasons I did a PhD. And then it just changes your mindset so much. It broadens what you're thinking and broadens how you look at things, you really start looking at systems, bigger pictures and we're just, I was just talking about that with Dr. Vanderlaan, here at UNLV, and it just changes how you think and how you look at problems. And getting people together, I think now what's so great is we're not doing this work alone. It's, most of what I do is in teams and there's nothing more that I love about coming together to solve a problem or we're just brainstorming, throwing things out that could be a possible solution, that's really out of the box thinking, and that's when creativity and innovation really happens and I think a PhD really prepares you well for that.
Joe Gaccione 16:07
That is all the time we have. Dr. Mollman, thank you so much for coming in today.
Sarah Mollman 16:11
I really enjoyed being here and being back on campus.
Joe Gaccione 16:14
To all our listeners out there, thanks for tuning in. Have a great day.
Transcribed by https://otter.ai