Pulmonary Rehabilitation a New Service at Norton County Hospital
Pulmonary rehabilitation is a new outpatient program at Norton County Hospital. It is recommended for patients with lung disease who experience shortness of breath frequently and are not able to perform daily activities despite daily use of medication. Many patients in rehabilitation programs have chronic lung diseases that limit breathing and activity. The program's manager explains more.
Featured Speaker:
Lacey Ninemire, RRT
Lacey Ninemire is the Cardiopulmonary Rehabilitation Manager at Norton County Hospital. She has been a respiratory therapist for seven years. Her experience ranges from Level I trauma centers to critical access hospitals. She has done cardiopulmonary rehab for over two years of that time. Transcription:
Pulmonary Rehabilitation a New Service at Norton County Hospital
Scott Webb: Pulmonary rehabilitation is for people who have ongoing breathing problems, including COVID long-haulers. And joining me today to tell us about the new pulmonary rehab program at Norton County Hospital is Lacey Ninemire. She's a registered respiratory therapist with Norton County Hospital.
From the Plains of Rural Northwest Kansas to you, this is Health in the Heartland presented by Norton County Hospital, where medical experts aim to empower health at any stage of life. I'm Scott Webb. Lacey, thanks so much for joining me today. I think most of us know what the word rehab means. But when you combine that with pulmonary and we say pulmonary rehab, what does that mean and who benefits from this program?
Lacey Ninemire: Pulmonary rehabilitation is a program of education and exercise to increase awareness about a patient's lungs and their disease that they may have. It benefits people who have diagnoses such as COPD, asthma, pulmonary fibrosis, pulmonary hypertension, weight-associated breathing disorders. And the big one right now is COVID-19.
Scott Webb: Yeah, I was wondering about COVID. I assumed that this would be sort of a perfect program for people who had COVID-19 or COVID-19 long-haulers. And when we think about folks and how they get to you, is it a self-referral program? Do they have to be referred from their primary? How does that work?
Lacey Ninemire: They do have to be referred. Usually, we'll get referrals from their pulmonologist or their primary. Here, since we have such a small patient population, if there are patients that I know that would benefit from it and qualify for it, I do reach out to their primary and then speak to them and see if it's something that they're interested in.
Scott Webb: Yeah, nice. They may not have thought of it and a little nudge from an expert like yourself I'm sure helps. And let's talk about that patient experience, right? So when they're a good candidate, they get referred and they get accepted, so to speak, into the program, what can they expect once they begin?
Lacey Ninemire: Usually, it's a 36-session program. We meet two to three times a week. Two is the minimum that you can meet. And if someone is absolutely super gung-ho, we can do it four days a week. But that first appointment that they're going to come to, it's just a lot of paperwork and we do a six-minute walk test. We use that for quality controls and tracking, because we do one pre- and then we do one post- and that helps show us improvement within the program. It shows us how well the patient has improved if they've improved at all. And then, once that first session is over, the rest of the sessions are going to be exercising and doing weights, bands. We actually will do chair yoga and then we do breathing exercises and then we'll do education. We'll do education a minimum of once every week, but it can be more depending on the patient and what their needs and their requests are.
Scott Webb: Yeah. And I'm sure that, you know, some of these things that you're discussing as a part of the program, I'm sure a lot of those things maybe are things that we could do from home, but I'm sure there's a real comfort in doing it with someone like yourself there with an expert there to help us, right?
Lacey Ninemire: Right now, you can do some of these at home. But the thing is a lot of people don't have the machinery that we use, or they don't have certain things at home that we have here. And it is great to come in and be monitored, like you said, by a professional. And most of these patients, when they come see us, they do need to see us because living with a pulmonary disease is very frightening and takes a lot of reeducation and educating, you know, that your life is going to change and how to be able to live a full life, but still dealing with those lung issues.
So that's one of the important things about pulmonary rehab is that we're going to give patients skills to help manage their pulmonary disease because most of your pulmonary diseases, once you are diagnosed with them and you have them, you never get rid of them. They usually are progressive. And so that's one of the great things about pulmonary rehab is that we are going to teach you about breathing and how you should breathe, why you should breathe the way that we're teaching you. We teach you about diet, because some foods can actually cause a person to have increased work of breathing. So we would go over all of that. And basically, our goal is to help the patient get a little bit better and to be able to live their life, and still have a quality of life with this pulmonary disease.
Scott Webb: Yeah, I see what you mean, that it's sort of like once you have a pulmonary disease, you're kind of always living with it and managing it. And it may get worse. And so having your expertise both in the short-term, long-term, breathing, foods to avoid and so on, it sounds really awesome. What's the end-game? When you think of outcomes, when do you see smiles on faces and what gives you the sense of that sort of "mission accomplished"?
Lacey Ninemire: Well, It kind of varies by patient. Whenever you start pulmonary rehab, you have to set goals and they have to be goals that are measurable and hopefully attainable. And they can be something as simple as being able to walk up and down the stairs twice in one day, because some of the patients that we see have a very hard time with shortness of air due to their pulmonary disease. And so what we do is we set these goals. And, usually for me, depending on the patient and how much effort they put into it and how much they listen and are receptive, we'll start seeing decent results within probably the first 15 sessions. But like I said, it's just each patient is completely different because some of the patients that we see are very bad. And, you know, even if we're just giving them coping techniques to help cope with everyday life things, sometimes for me, it's rewarding for someone to say and tell me, "I didn't get quite a short of breath doing this as I normally do." So sometimes for me, that's a win, that's a huge win for certain patients. It's very much individually based on the patient.
Scott Webb: Why is it so important to have this program at Norton County Hospital?
Lacey Ninemire: First of all, there's not a lot of programs around here. There's only one, maybe two, that I can think of within probably a 50 to 60-mile radius of our facility. We do have a very large population that are older. And we also live in an area where you do see a lot of lung injuries, whether it's from smoking, farming, the dirt, chemicals, things like that. We do have a lot of patients out there that do qualify for this program. And it's just nice to have it and it's something that we can offer all of our patients and it's something that they can come and get in their hometown and they don't have to travel to other towns to try and find it.
Scott Webb: Just a little bit of focus on you, not to embarrass you, but you do a lot there. And now, you're taking over cardiac rehab duties at the hospital. How do you balance all of this?
Lacey Ninemire: I have a lot of binders and I have a lot of step-by-step processes. I love both cardiac and pulmonary rehab because it's a lot of one-on-one patient time and you really get to see positive outcomes whenever you do pulmonary and cardiac rehab, because you are so one-on-one with the patient and it is a longer session time and it makes it worthwhile, but know there's a lot of organization that goes into being able to balance both of them.
Scott Webb: I'm sure. I'm sure they're well-stocked in binders for you, and that it's good to know. As we wrap up here, you know, I mentioned it's a smaller rural hospital and having programs like this are pretty amazing. So what's it like for you to lead these programs in a smaller hospital, a critical access hospital versus some bigger hospital that might be quite a distance away?
Lacey Ninemire: Honestly, one of the bigger things is we just don't have quite as much room and we don't have quite as many of the pieces of equipment that you can have. Depending on where you are, where you go and stuff, I mean, there are so many different pieces of equipment that you can have access to, especially in a larger facility. Whereas here, you know, we're just a little bit more crunched for space, but we still have four very important pieces of equipment here. And we have weights and we have resistance bands and we're going to be starting yoga, chair yoga anyway. So really, the only difference from here versus there is just space.
Scott Webb: Yeah. I hear what you're saying. And, as you say, you've got the really important machines. Sure, maybe you could use a little more space. But the most important thing I think for folks that need this program, need pulmonary rehab, is they've got people like yourself, experts like yourself and your team to work with them. So thanks so much. This has been really educational. You stay well.
Lacey Ninemire: Thanks. You too.
Scott Webb: For more information about Norton County Hospital, visit ntcohosp.com. Thanks for listening to Health in the Heartland. I'm Scott Webb. Stay well.
Pulmonary Rehabilitation a New Service at Norton County Hospital
Scott Webb: Pulmonary rehabilitation is for people who have ongoing breathing problems, including COVID long-haulers. And joining me today to tell us about the new pulmonary rehab program at Norton County Hospital is Lacey Ninemire. She's a registered respiratory therapist with Norton County Hospital.
From the Plains of Rural Northwest Kansas to you, this is Health in the Heartland presented by Norton County Hospital, where medical experts aim to empower health at any stage of life. I'm Scott Webb. Lacey, thanks so much for joining me today. I think most of us know what the word rehab means. But when you combine that with pulmonary and we say pulmonary rehab, what does that mean and who benefits from this program?
Lacey Ninemire: Pulmonary rehabilitation is a program of education and exercise to increase awareness about a patient's lungs and their disease that they may have. It benefits people who have diagnoses such as COPD, asthma, pulmonary fibrosis, pulmonary hypertension, weight-associated breathing disorders. And the big one right now is COVID-19.
Scott Webb: Yeah, I was wondering about COVID. I assumed that this would be sort of a perfect program for people who had COVID-19 or COVID-19 long-haulers. And when we think about folks and how they get to you, is it a self-referral program? Do they have to be referred from their primary? How does that work?
Lacey Ninemire: They do have to be referred. Usually, we'll get referrals from their pulmonologist or their primary. Here, since we have such a small patient population, if there are patients that I know that would benefit from it and qualify for it, I do reach out to their primary and then speak to them and see if it's something that they're interested in.
Scott Webb: Yeah, nice. They may not have thought of it and a little nudge from an expert like yourself I'm sure helps. And let's talk about that patient experience, right? So when they're a good candidate, they get referred and they get accepted, so to speak, into the program, what can they expect once they begin?
Lacey Ninemire: Usually, it's a 36-session program. We meet two to three times a week. Two is the minimum that you can meet. And if someone is absolutely super gung-ho, we can do it four days a week. But that first appointment that they're going to come to, it's just a lot of paperwork and we do a six-minute walk test. We use that for quality controls and tracking, because we do one pre- and then we do one post- and that helps show us improvement within the program. It shows us how well the patient has improved if they've improved at all. And then, once that first session is over, the rest of the sessions are going to be exercising and doing weights, bands. We actually will do chair yoga and then we do breathing exercises and then we'll do education. We'll do education a minimum of once every week, but it can be more depending on the patient and what their needs and their requests are.
Scott Webb: Yeah. And I'm sure that, you know, some of these things that you're discussing as a part of the program, I'm sure a lot of those things maybe are things that we could do from home, but I'm sure there's a real comfort in doing it with someone like yourself there with an expert there to help us, right?
Lacey Ninemire: Right now, you can do some of these at home. But the thing is a lot of people don't have the machinery that we use, or they don't have certain things at home that we have here. And it is great to come in and be monitored, like you said, by a professional. And most of these patients, when they come see us, they do need to see us because living with a pulmonary disease is very frightening and takes a lot of reeducation and educating, you know, that your life is going to change and how to be able to live a full life, but still dealing with those lung issues.
So that's one of the important things about pulmonary rehab is that we're going to give patients skills to help manage their pulmonary disease because most of your pulmonary diseases, once you are diagnosed with them and you have them, you never get rid of them. They usually are progressive. And so that's one of the great things about pulmonary rehab is that we are going to teach you about breathing and how you should breathe, why you should breathe the way that we're teaching you. We teach you about diet, because some foods can actually cause a person to have increased work of breathing. So we would go over all of that. And basically, our goal is to help the patient get a little bit better and to be able to live their life, and still have a quality of life with this pulmonary disease.
Scott Webb: Yeah, I see what you mean, that it's sort of like once you have a pulmonary disease, you're kind of always living with it and managing it. And it may get worse. And so having your expertise both in the short-term, long-term, breathing, foods to avoid and so on, it sounds really awesome. What's the end-game? When you think of outcomes, when do you see smiles on faces and what gives you the sense of that sort of "mission accomplished"?
Lacey Ninemire: Well, It kind of varies by patient. Whenever you start pulmonary rehab, you have to set goals and they have to be goals that are measurable and hopefully attainable. And they can be something as simple as being able to walk up and down the stairs twice in one day, because some of the patients that we see have a very hard time with shortness of air due to their pulmonary disease. And so what we do is we set these goals. And, usually for me, depending on the patient and how much effort they put into it and how much they listen and are receptive, we'll start seeing decent results within probably the first 15 sessions. But like I said, it's just each patient is completely different because some of the patients that we see are very bad. And, you know, even if we're just giving them coping techniques to help cope with everyday life things, sometimes for me, it's rewarding for someone to say and tell me, "I didn't get quite a short of breath doing this as I normally do." So sometimes for me, that's a win, that's a huge win for certain patients. It's very much individually based on the patient.
Scott Webb: Why is it so important to have this program at Norton County Hospital?
Lacey Ninemire: First of all, there's not a lot of programs around here. There's only one, maybe two, that I can think of within probably a 50 to 60-mile radius of our facility. We do have a very large population that are older. And we also live in an area where you do see a lot of lung injuries, whether it's from smoking, farming, the dirt, chemicals, things like that. We do have a lot of patients out there that do qualify for this program. And it's just nice to have it and it's something that we can offer all of our patients and it's something that they can come and get in their hometown and they don't have to travel to other towns to try and find it.
Scott Webb: Just a little bit of focus on you, not to embarrass you, but you do a lot there. And now, you're taking over cardiac rehab duties at the hospital. How do you balance all of this?
Lacey Ninemire: I have a lot of binders and I have a lot of step-by-step processes. I love both cardiac and pulmonary rehab because it's a lot of one-on-one patient time and you really get to see positive outcomes whenever you do pulmonary and cardiac rehab, because you are so one-on-one with the patient and it is a longer session time and it makes it worthwhile, but know there's a lot of organization that goes into being able to balance both of them.
Scott Webb: I'm sure. I'm sure they're well-stocked in binders for you, and that it's good to know. As we wrap up here, you know, I mentioned it's a smaller rural hospital and having programs like this are pretty amazing. So what's it like for you to lead these programs in a smaller hospital, a critical access hospital versus some bigger hospital that might be quite a distance away?
Lacey Ninemire: Honestly, one of the bigger things is we just don't have quite as much room and we don't have quite as many of the pieces of equipment that you can have. Depending on where you are, where you go and stuff, I mean, there are so many different pieces of equipment that you can have access to, especially in a larger facility. Whereas here, you know, we're just a little bit more crunched for space, but we still have four very important pieces of equipment here. And we have weights and we have resistance bands and we're going to be starting yoga, chair yoga anyway. So really, the only difference from here versus there is just space.
Scott Webb: Yeah. I hear what you're saying. And, as you say, you've got the really important machines. Sure, maybe you could use a little more space. But the most important thing I think for folks that need this program, need pulmonary rehab, is they've got people like yourself, experts like yourself and your team to work with them. So thanks so much. This has been really educational. You stay well.
Lacey Ninemire: Thanks. You too.
Scott Webb: For more information about Norton County Hospital, visit ntcohosp.com. Thanks for listening to Health in the Heartland. I'm Scott Webb. Stay well.