2007 excellence in clinical practice/non-traditional setting award.

As a young adult, I left rural Alabama and saw the world through travel experiences as a Navy corpsman. These experiences taught me that people, regardless of their culture, ethnicity or geographic location, need the interventions and insights of caring nurses. One of the purposes of my life has been to lead efforts to improve the health of my community, region and the world. This aim has been pursued through the support of my family, hospital, church and the local AACN chapter.

My daily efforts are focused locally. As an outreach of our church, I manage a food bank. I also volunteer to perform health screenings and evaluations at Drummond Coal Mines. My acute care facility is located in a distressed urban neighborhood. The managers of our acute care facility contribute through construction work, serving as readers and resources to the local schools, and lobbying for healthcare access for the uninsured. My local AACN chapter helps our schools in this area by obtaining supplies like toothbrushes, Band-Aids, over-the-counter medicines and small Christmas presents for the school nurse to distribute.

At the regional level, I am in a group that takes a healthcare van to the Black Belt of Alabama. This outreach uses rural churches so that patients without access to care or financial resources can have their wounds cleaned and evaluated, education relevant to prevention of hypertension and diabetes, and health screenings.

My community also encompasses the world. I have traveled to Africa and Central America as part of a medical mission's team. The needs there are basic; however, by providing nutrition and simple medical care, these communities are able to continue their existence. My time in these regions has opened my eyes to populations that have so little but are grateful and gracious.

Critical care has expanded beyond the traditional setting, thus requiring critical care nurses to work in nontraditional areas such as emergency rooms, catheter labs, operating rooms and even home healthcare. However, another area of nursing practice utilizes critical care nurses to provide uninterrupted care along the continuum in an effort to improve patient care outcomes. This area is hyperbaric medicine.

For those not familiar with hyperbaric medicine, hyperbaric oxygen (HBO) is used to treat a variety of critical illnesses such as arterial gas embolism, carbon monoxide poisoning, gas gangrene, necrotizing fasciitis and acute arterial insufficiency/crush injuries. These patients are often intubated, have numerous lines including arterial, Swan and central, and may require ongoing fluid resuscitation and inotropic support. This "ICU" is in a confined area, separated from the outside world by 6 inches of steel. The patient receives 100% oxygen while in a pressurized environment to assist with treatment of the illness. The goal is for the patient to receive uninterrupted care while meeting the standards of the ICU and HBO. Therefore, the nurse must demonstrate competence in both areas.

Scott, a 34-year-old healthy male, developed a rapidly spreading necrotizing fasciitis in his L-chest (B-hemolytic Strep). As the on-call RN for HBO, I was called in to dive with Scott his first time. He was very ill and in need of a great deal of coordination for HBO, medical and nursing care. His intensivist, the HBO team and I worked together to coordinate his care. I treated Scott many times in HBO and provided both physical care and psychological support to him and his family in the medical-respiratory ICU where I have been employed full time for 28 years.

Scott did survive and recovered after many reconstructive surgeries and returned to his same active lifestyle.

Billy J. Gilliland, ASN, RN

Princeton Baptist Medical Center, Birmingham, AL

Lynne Nevers-Hoeft, RN, BSN, CCRN 

Aurora St. Luke's Medical Center, Milwaukee, WI