By Marti Faulkner, RN, Wesley Nurse, 

I remember going hunting for rabbits with my grandfather when I was little. He would shoot them; I would get out of the car and get the rabbit to place it in the ice chest in the back of the car. Then we would slowly drive down the road waiting for our next dinner to hop up in our path. Those times were precious to me and I have many memories of harvesting dinner with my grandfather. One memory, in particular, stands out to me the most: We were hunting in New Mexico on some old oil field dirt roads in the middle of nowhere. It had snowed quite a bit and everything was covered with a white blanket. When my grandfather shot the first rabbit, I was surprised at how bright the blood appeared on the snow. I was about 10 years old and decided it was really creepy so I tried to cover it up. I would kick snow on top of the blood, but the blood kept seeping through. I couldn't figure out why, but I worked harder and put on more snow until I couldn't see it anymore. Little did I know that this memory would be very significant to me and the impact that I make on my patients.

Mental health is an issue that often goes unaddressed. During the holidays you see an increase in suicides and the inpatient mental health units tend to fill up. People become impatient with each other and often times feelings are hurt and things are said that can't be undone. I try to think of each person in my life as snow and this is why. The snow sparkled in the sun and was a beautiful cover across the fields. We all know snow is frozen, yet the blood of that rabbit was hot. When I put new snow on top of it, the blood would melt the new snow and the blood would show through. The blood reminds me of an emotional injury, once it's there it burns hot and takes a lot of work to cover up. The new snow being placed on top of the blood reminds me of positive things trying to cover up the hurt from an emotional injury. In the beginning, it keeps melting and the injury shows through. Once the blood is finally the same temperature as the snow, when it has had time to cool off, you can begin to make progress in covering it up. This is when it quits melting the new snow or when a person begins to heal. It takes a lot of rebuilding and positive reinforcement and actions to help someone recover from an emotional injury.

When you are dealing with people that are injured, it may take a lot of snow to make that beautiful fresh blanket be untarnished again. This takes time and patience – that is why it is important for us to build relationships with our patients. When you are dealing with a patient, friend, family member or even a stranger, always think before you act out of frustration or anger. Ask yourself a single question: "How much snow will it take to cover up what I am about to say or do?"

Methodist Healthcare Ministries of South Texas Inc., has recently collaborated with Medtronic, a global leader in medical technology, to introduce the Medtronic Turning Point program to Methodist Healthcare Ministries’ patients with diabetes. As part of the program, patients work alongside a health partner and track their diabetes information on an innovative phone app. We sat down with Christopher Martinez, RN, WCC, a Medtronic Turning Point health partner housed at Wesley Health & Wellness Center – a clinic owned and operated by Methodist Healthcare Ministries – who is dedicated to helping patients succeed.

Q: What’s your role at Wesley Health & Wellness Center?
I’m the face-to-face representative for Medtronic. I have an assigned group of 8-10 patients, and I’m their health partner. Besides enrolling patients in the program and helping them with any equipment troubleshooting, I review their patient profile and look at how they’re doing with their diabetes.

Q: How does the Medtronic program work?
It’s a six-month program. We do our best to keep patients engaged with in-person or phone call check-ins, and our patients agree to keep an open line of communication with us. Patients use a smartphone which contains a free app they use to monitor their diabetes progress, and information gets routed to a Wesley Health & Wellness Center health educator and me. If we see something that needs to be addressed, the health educator relays that directly to the patient’s physician. That way we’re doing it sooner rather than later, since waiting until the patient’s next appointment could lead to complications.

Q: How can you join the program?
Methodist Healthcare Ministries offers this program to its patients free of charge. Wesley Health & Wellness Center’s health educators first screen Methodist Healthcare Ministries’ patients to make sure they meet the program’s enrollment criteria. For example, candidates must be 18 years or older, have an A1C level of nine or above, have some understanding of smartphone use, etc. If they meet the criteria, the health educator informs the patient of the Medtronic program and if they’re interested I get the green light. I meet with the patient – and with the health educator to keep that rapport – and I’ll explain the program in more detail. If the patient then wishes to enroll, they’re given all program related materials and education is initiated. Sometimes we even work with a patient’s family member. You find that a lot in the Hispanic community; the wife takes care of the husband and prepares his meals and gives him medication.

Q: How does the app work?
The app tracks a number of things besides blood glucose levels. Based on our conversations, and on their medications, I teach the patient how to utilize the best trackers for their care. For example, if they have a rapid-acting insulin that needs to be adjusted per meal, then we make sure they check their sugar prior to every meal and they document it on the app. They can even photograph their meal and send it to me, and I can count their carbs. I then help them do their own carb counting. We can track their blood pressure, sleep patterns, weight, and then decipher the data and trends. There are so many things we can do to empower them to become more independent … and that’s the goal. In six months, I want to provide them with enough information so they can independently manage their diabetes and understand how it relates to their diet, activity, rest, stress and medication.

Q: How’s the dynamic at Wesley Health & Wellness Center?
We’re the intermediary between the patient and the clinic. We’re not here to replace any of the many disciplines at Wesley Health & Wellness Center that do a great job; we’re here to enhance what they’re trying to do. The clinic is kind of like a one-stop shop. I’m blown away by all the services. As a health partner, I think, “Oh you’re having problems with that? Guess what, Wesley has this health class or exercise program you can tap into.” It makes my job easier.

Q: How do you advise patients?
I let them know how they’re doing in the program with an average or estimated A1C to give them awareness and help them succeed. If I see elevated blood sugar, I ask what they may have eaten and we discuss how they can prevent that from going higher/lower next time. It can be difficult to manage your diabetes after you leave the clinic so we try to give guidance and fill that void. We calm patients, or if necessary, we advise them to move up their doctor’s appointments so their diabetes doesn’t get so severe they need to go to the emergency room. We help patients meet their goals and get their A1C lower. There’s a lot of myth in diabetes. Some think, “When I was a kid, I drank a lot of soda and that’s why I have diabetes.” But it doesn’t work that way. It’s important to touch on that because it can affect patients.

Q: How have you seen the program succeed?
We’ve recently obtained information on how well the program is working. Some patients’ diabetes is severe. I recall the highest A1C I saw was 13%, and we were able to bring that down. While results may vary, on average we’ve been able to bring A1C numbers down 2.0 points amongst Methodist Healthcare Ministries’ patients. I have patients that have shown remarkable results with their A1C in the six-month duration – some as early as four months!

Q: What are some of your favorite patient stories?
I had one patient who was extremely happy she was getting dentures – the ones that snap into place, not just the adhesive kind. I had connected her with Wesley’s dental services. She asked me, “I don’t have teeth, why should I go to dental?” After explaining why and working side-by-side with Wesley’s health educators, she was ecstatic saying, “Next time you see me you’re going to see me with a beautiful smile!” It was so sweet.

One of my patients lost more than 20 pounds within the first four months. I helped talk her through her diet and exercise, and her energy levels got higher and her blood sugar got better. It’s a big deal. Her family took note of that and praised her. She also became the center of attention at her church to spread that ‘you too can do it.’ She’s a rockstar in her church community.

Another patient of mine who’s a chef at a ministry has now gotten his assistants to prepare healthy meals. He’s spreading that knowledge and experience in the ministry. He’s even got his running shoes now – he leads a walking group.

You can’t help but develop sort of a level of friendship; you develop that rapport.

Q: How do you help patients the most?
I think it’s the fact that we’re there for patients, providing a wealth of knowledge. One main struggle with diabetes in knowledge deficit. There’s so much to learn about it. Sometimes it can be overwhelming for a patient, so we take it slow. They can take their blood sugar, but after taking 2-4 a day you can get lost in those numbers, so it’s helpful when you can put it into perspective. We try to help modify some of their behaviors, through diet, exercise or medication compliance and we hold them accountable. Not strict, but we do hold them accountable. I take every opportunity to teach something. Patients don’t make mistakes; I just look at it as ‘what can we do differently.’ When you hear them repeat your same words 3-4 phone calls later, it’s cool to know they’ve learned and are applying it to their care plan.

Q: What’s something you’ve learned?
We’ve created a foundation with Wesley Health & Wellness Center. The clinic has played a huge role in how we’ve polished our processes. I’m grateful for that. We’ve learned a lot. We now try to maintain the same model with other clinics. I’ve got nothing but love for Wesley.

By George Thomas, chief operating officer

As Chief Operating Officer at Methodist Healthcare Ministries, preparing for the new year means looking at the closing year to evaluate the degree to which the organization's operations achieved the objectives set by our board of directors and what processes are needed to achieve our goals or build upon them moving forward. As they say, "Hindsight is 20/20." There is always more we can do to improve—especially when I think about the lives this organization touches. We must constantly challenge ourselves to ask: "What can we do better, more efficiently, or in a way that more people can be served?" and "How can we be sure we are making a measurable, positive impact in our patients' health outcomes?" I know every team member at Methodist Healthcare Ministries is driven by the desire to do more for our patients; to make our communities healthier. It's why we invest so heavily in our performance management systems and utilize evidence-based models of care to ensure we offer the highest degree of quality in our programs and services. That investment and focus on quality is why Methodist Healthcare Ministries recently captured the attention of the Agency for Healthcare Research and Quality (AHRQ) – the lead federal agency charged with improving the safety and quality of America's health care system. AHRQ recently featured Methodist Healthcare Ministries' Wesley Health & Wellness Center in San Antonio as part of their New Models of Primary Care Workforce and Financing study which examines the workforce that is needed to deliver fully comprehensive, high-quality primary care across the United States.

They visited with us in April to get a full view of our model of care, including our staffing structure and how it influences patient care. We spoke on how motivational interviewing training for our teams helps us to facilitate personal growth and behavior change in our patients/clients. And, we talked about how de-escalation education helps to provide our clinicians and front line staff with techniques to prevent the intensification of risky or potentially harmful situations. Their focus and interest centered on how we create and maintain an integrated care model, with consideration to the social determinants of health and how our holistic programming influences our patients' outcomes.

We also explored how morning huddles keep our interdisciplinary team on the same page, how rounding gives us consistent and steady feedback, and spoke to the importance of co-location – all being under the same roof.

Beyond in-person and inter-care collaboration, we highlighted how internal electronic health records, and our involvement in a citywide health information exchange network, help to keep clinicians well informed of patient history and better manage care. We explained how warm handoffs between our medical, dental and behavioral health team help us to build trust with our patients while providing comprehensive care, and how to meet the cultural needs of our patient population. And, of course, we stressed the high value we place on training and professional development as part of continuous quality improvement.

Hindsight is indeed 20/20. Looking back at these last few years, and seeing the culmination of all the organization's hard work being reflected in the AHRQ study, gives me great pride and motivates me to do more for our patients and clients. From the provision of services to those we fund through partnerships, this organization has made great strides in creating access to quality care for our patients, but also helping them to achieve better health outcomes. Above all, I am proud of the dedication and hard work our team puts into bringing life to our mission of "Serving Humanity to Honor God."

By Matthew Martinez, recreation & enrichment specialist

Proverbs 16:9 – In his heart, a man plans his course, but the LORD determines his steps.

Doing my job requires that I give a lot of myself – physically, mentally and spiritually. I've been working at Methodist Healthcare Ministries as a recreation & enrichment specialist for two years now, but not a single day has been as rewarding as the day that I put on, 'the Santa suit.'

It was a typical Friday in December, filled with a lot to do and little time to do it. The one difference was that today, Dustin, our multimedia production coordinator, was going to record our department for the MHM Christmas video. I along with all of my team members, gathered in the gym to shoot our clip. That's when I was handed a Santa coat and hat. For some reason, joy filled my heart in a way that it hadn't in a while at work. After we finished shooting the scene, I was told that the rest of the suit was in the storage closet. I don't know why, but for some reason, I felt God calling me to the suit. One of my co-workers tested me and said, "You won't wear that all day," and so I accepted that challenge and did.

It started as just a silly way of walking around the building, but then, after putting on the wig, beard, pants, boots, jacket, and hat, something changed. I found myself smiling under that beard and wanting to make everyone else smile as well. So I made my way around Wesley Health & Wellness Center, the clinic owned and operated by Methodist Healthcare Ministries. I went to the dental, medical, and parenting areas, the kitchen and even the pharmacy. All along the way, I was stopped by employees and clients alike, smiling and wanting to take a picture with Santa Clause. In all my time at Methodist Healthcare Ministries, I've been a part of many smiles and even some tears, but no memory will ever stick to my mind as well as this one. I made employees who were weary from another hard year of work smile and laugh. I made clients from as young as a few months to the seniors in our classes smile when things outside of this building are often too hard to allow for smiling.

I will always remember the day I put on that suit. For that one day, I was more than just a recreation & enrichment specialist; I was a glimmer of hope for many, a reminder that through God's love and compassion nothing is ever too hard to overcome. My original plans for that suit led me to put it on, but God led me to bring a little bit of Christmas joy to those at Wesley Health & Wellness Center.

by Rhonda S. Hunnicutt, RN, Wesley Nurse

At our previous Wesley Nurse forum, we had a wonderful group of presenters from Living Compass, a Christian-based program that integrates faith and wellness. Their message was about simplicity. Simplicity is a concept I am trying to embrace; it's a challenge, but I continuously try to work at it. With Christmas approaching, my family and I have been focusing more on the reason for the season, Christ's birthday. Also, instead of traditional gifts, we're giving each other the gift of time, as everyone is busy these days. I'm equally reminded of how precious our time is with loved ones and dear friends. A friend of mine recently lost her battle with cancer, she was only in her early 60s. I was able to spend a few final minutes with her, sometimes just filling the time with silence, but it was understood just how much that time meant.

When I was at the Luling Area Ministerial Alliance Food Bank recently, the thoughts flooded over me again about how much we have that we sometimes take for granted. I had packed some items to donate to the food bank's clients, and at the last minute thought to add some jump ropes to my bag. While I was there, a mom with a little girl around four years old came in. Even though I thought she may be a little young for it, I asked the girl if she'd like a jump rope. Her eyes lit up, and she ever so politely said, "Thank you, I've always wanted a jump rope." It was evident that this simple gift meant so much to her. I had to fight back tears. As the little girl left, she wished me a Merry Christmas. I think it was the most special Christmas wish I will ever remember!

This simple gift required such little effort on my part, but meant the world to one little girl. As we go through the rest of the Christmas season and into the next year, I hope this story resonates with you as it touched me, so that not just at Christmas but all year long, we can look past a person's surface and see that there is more than meets the eye to everyone we see. Everyone has a story. When you see a downtrodden person walking down the street, what are your thoughts or actions? The grumpy man in the grocery store – do we stop to find out that his wife passed away last year, and that this is a hard time of year for him? Or the quiet person on the sidewalk – do we stop to find out if this person is perhaps a veteran who is now battling mental health issues due to post-traumatic stress disorder? Is he or she suffering in silence, longing for just a moment of eye contact and a simple "hello?"

We can give such simple gifts that mean so much to someone else without it costing anything but our time. Until next time, be well and be blessed.

Rhonda Hunnicutt, RN, is a Wesley Nurse with Methodist Healthcare Ministries of South Texas, Inc. Methodist Healthcare Ministries' Wesley Nurse program is a faith-based, holistic health and wellness program committed to serving the least served through education, health promotion and collaboration with individual and community in achieving improved wellness through self-empowerment. Learn more at www.mhm.org. 

By Edlín Maldonado-Fuller, collaborative grants specialist

"Financial empowerment services help our patients see the bigger picture, to help them plan for the long term." – Monica Lucero, Behavioral Health and Social Work Supervisor

While access to care plays an essential role in helping to improve the overall health of our communities, even greater are the non-clinical factors, such as income and employment. Earlier this year, Methodist Healthcare Ministries of South Texas, Inc. partnered with the Family Service Association of San Antonio's Financial Empowerment Center to offer one-on-one financial counseling to Wesley Health & Wellness Center patients as part of our holistic approach to care.

Many times, when patients meet with a Methodist Healthcare Ministries social worker, financial issues and concerns arise. The social work case manager works with the financial empowerment counselor to help patients engage in support services, such as individual financial counseling. With an on-site financial empowerment counselor, patients benefit by having access to services and not needing to travel. In addition, there are educational workshops for small groups.

As the program is in its pilot year, Methodist Healthcare Ministries is monitoring levels of depression and anxiety to determine whether these concerns, associated with financial stress, can be lowered over time – thus improving a patient's overall health. Methodist Healthcare Ministries and the Financial Empowerment Center hope to take this information and work to improve services to achieve better health and financial outcomes of individuals. Clinical care contributes about 20 percent to someone's health, while social and economic factors contribute about 40 percent. By bringing two different sectors together– a social worker and financial empowerment counselor – to address a patient's needs, the partnership has the potential to achieve greater, significant impact in an individual's life.

The Financial Empowerment Center is a national initiative that launched in 2013 with support from Bloomberg Philanthropies. San Antonio was blessed to be one of five initial cities selected. Since opening its doors on the city's West Side, the Financial Empowerment Center has helped families reduce over $5 million in debt, accumulated over $400,000 in savings, and helped 20 families buy a home. This is extremely remarkable given the average annual income for Methodist Healthcare Ministries' patients is about $23,000. For many families, this figure is below the federal poverty level. Fortunately, these services do not have income restriction or eligibility requirements and anyone in the community can access the service for free. In addition to being co-located at Wesley Health & Wellness Center, Financial Empowerment Services has several sites throughout the city. A true community partner, they have connected with local organizations such as Haven for Hope and the Westside Education & Training Center.

In November, Family Service Association's Financial Empowerment Center received an honorable mention for Mutual of America's 2016 Community Partnership Award. It is truly exciting patients are receiving services from a national, award-winning program. Join us in congratulating an outstanding organization of our community!

Edlín Maldonado-Fuller is the Collaborative Grants Specialist for Methodist Healthcare Ministries. She provides technical assistance to community partners in Methodist Healthcare Ministries' service regions, ranging from grant-writing, vetting grant opportunities, supporting collaborative funding initiatives and sharing information about development resources.

By Janet Crain, RN, Wesley Nurse

November is American Diabetes Month® and the beginning of the holiday season! As hard as you've worked to stay on course with managing your diabetes throughout the year, the holiday season has the potential to throw you off. Travel, parties, big meals, snack foods at the office and drinking all create a challenging environment for eating healthy. Add to that the days of travel with little scheduled exercise, and it becomes a real effort to stay on track. "How can I eat healthy during the holidays?" It's one of the most common questions asked by people with diabetes—or anyone who's made a commitment to eating with their health in mind.

If you follow these strategies, you can maintain your blood sugar levels and enjoy the parties and gatherings along with everyone else. However, just like everything else with diabetes, you have to take a few extra steps:

• Eat breakfast or snacks earlier in the day and avoid the idea of sav­ing carbs for the big feast later on. Eat a small, balanced meal before you leave home to avoid overindulging. If you skip meals, it may be harder to manage your blood sugar.
• Limit the number of serv­ings of starchy foods on your plate. It might be tempting to have some mashed potatoes, sweet potato casserole and rolls; however, try to choose just one of these items. If you have a sweet treat, cut back on other carbohydrates (like potatoes and bread) during the meal.
• Choose vegetables first and choose fruits and vegetables served raw, grilled or steamed. Avoid vegetables in creams, gravies and butter.
• Stick to calorie-free drinks such as water, tea, selt­zer or diet sodas instead of punch or mixed drinks. Sip a large glass of water or mineral water to keep you hydrated and provide you with a better option than alcohol.
• If you choose to drink alcohol, limit the amount and have it with food. Talk with your health care team about whether alcohol is safe for you. Women should drink no more than one alcoholic beverage a day and men should drink no more than two.
• Enjoy your favorite holi­day treats, but take small portions, eat slowly and savor the taste and texture. Offer to bring a healthy dish along to the party so that you will have more healthy food choices.
• Try not to hang out near the food to avoid grazing. Find a comfortable spot across the room and focus on socializing instead of eating.
• After your meal, take a walk with family and friends. Exercise will also get you moving, keep you focused on your goals, and give you a welcome break from being surrounded by treats. Exercise is also a great way to lower blood sugar levels.
• If you overindulge, don't beat yourself up. If you eat more carbs or food than you planned for, don't think you have failed, just make a plan to get back on track.
• If you go out more often and stay out later during the holidays, you're likely to get less sleep. Sleep loss can make it harder to control your blood sugar. Also, when you're sleep deprived you'll tend to eat more and prefer high-fat, high-sugar food. Aim for 7 to 8 hours per night to guard against mindless eating.

Most of all, remember what the season is about—celebrating and connecting with the people you care about. When you focus more on the fun, you won't focus as much on the food!

Learn more by visiting the following websites:
https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/AADE_Holiday_toolkit.pdf 
http://www.cdc.gov/features/diabetesmanagement/ 

Janet Crain, RN, is a Wesley Nurse with Methodist Healthcare Ministries of South Texas, Inc. Methodist Healthcare Ministries' Wesley Nurse program is a faith-based, holistic health and wellness program committed to serving the least served through education, health promotion and collaboration with individual and community in achieving improved wellness through self-empowerment. Learn more at www.mhm.org. 

By Carol Chavez, regionalization & partnership specialist

On my first day as a regionalization & partnership specialist for Methodist Healthcare Ministries, I hit the ground running and traveled to Brownsville, Texas, on a Sunday afternoon to attend our Sí Texas Project Convening and Evaluation Learning Collaborative sessions. Throughout the four-hour drive, I kept mentally going over potential topics of conversation. I was excited to meet our funded partners and start developing a rapport. I took that first opportunity to network with key individuals and began building relationships with sub-grantees, executive directors and other associates from partner nonprofits. Nearly a year later that continues to be the foundation of my role: forming long-lasting, valuable and trustworthy relationships with our funded partners and with community members in our 74-county service area in South Texas.

Part of my job is to also assist in managing Methodist Healthcare Ministries' Eugene Washington Patient-Centered Outcomes Research Institute (PCORI) award. The community engagement five-part series titled, Advancing Health in South Texas, aims to gather patients and key stakeholders across a 20-county area to develop a coordinated regional approach for patient-centered research and evaluation among university systems, academic institutions, managed care organizations and public health systems. The objective is to learn about patients' perspectives and important health issues in their communities to better frame conversations with stakeholders.

A month into my position, in early February 2016, I coordinated the first PCORI Engagement Series Session: What Matters to You? Methodist Healthcare Ministries, along with our partner Health Resources in Action (HRiA), hosted six, two-hour focus groups in Cameron, Hidalgo, Jim Wells, Nueces, Webb and Zavala counties. I called this trip the "South Texas county tour." Our ambitious goal was to complete all six focus groups in three days.

Hearing firsthand from community members was a great learning opportunity. I learned that wait times to see a doctor ranged from one month to six months. Some patients shared that after hours of waiting for a doctor they'd be called in only to be left confused and frustrated because the doctor didn't speak the same language. Patients expressed that they did not have a trusting relationship with their providers. It was heartbreaking to also learn that critical prenatal care was not easily accessible.

Many communities both in the Rio Grande Valley and Coastal Bend areas have a great need for Methodist Healthcare Ministries' services – to facilitate health care access, to convene key stakeholders, and to connect communities with local not-for-profits and health care providers. Being part of Methodist Healthcare Ministries' community engagement work allows me to be an advocate and bring community voices to the forefront. It enables me to be part of the conversation of health inequalities so I can work on solutions for better health services in rural areas. I believe Methodist Healthcare Ministries is creating a significant platform by bringing down communication barriers between patients and system level stakeholders so that together they can discuss opportunities to increase access and improve health.

In my new role I have a new lens and I can see our organization is on the path to implementing groundbreaking initiatives between health care systems and regional communities to impact many lives. By continuing to connect with communities, we truly bring our organizational mission into action: Serving Humanity to Honor God by improving the physical, mental and spiritual health of those least served.