Flex Friday: Tolu Adewole

Welcome to another Flex Friday feature of the 2023/24 academic year! This week, we are introducing Tolu Adewole, a degree-holder student completing her preceptorship this fall. Tolu shares her experiences in precepting as a rural nurse, and her important work in bringing diversity to health care through her research efforts. Meet Tolu!

Can you please explain your journey to nursing?
“I am a degree-holder, so I completed my first degree in psychology with a minor in mathematics from the University of Ottawa. I moved to Toronto because I wanted to be a psychologist, and I was working at the Centre for Addiction and Mental Health. [When working], I learned that almost everyone I saw with a mental disorder also had a physical comorbidity. So, I wanted to understand the bigger picture of health and disease to know what to do when someone is bleeding or someone can’t breathe. I went into nursing because I felt it was a good balance between mental health and physical health.”

Why did you choose to study nursing at the University of Calgary?
“I was interested in studying at UCalgary because I have lived in Canada for eleven years now, and have lived in about nine or 10 cities, so I have moved around every few years. Part of the reason why is, I am very curious about places. So, when I was going back to school, I wanted to try something new: the West!”

Where did you live before coming to Canada?
“I was raised in Nigeria until the age of 15 and moved to Canada as an international student then, which means most of my family is still back home.”

Did growing up in Nigeria contribute to your interests in health care?
“Most definitely. For me, it was the lack of access to health care. There are nurses and doctors…but it’s the fact that people have to pay for it. For example, one of my cousins was caught in a house fire, so I called from Canada to ask if he’s going to the hospital, but he said he doesn’t have enough money to go. He said he only has enough money to decide between a bag of rice and going to the hospital, so he chose the bag of rice.

“Growing up in Nigeria, I didn’t experience that in a middle-class family, but many Nigerians face that. Driving in traffic in the morning and seeing that people could not afford health care, seeing people on the street with placards asking for money while driving in traffic in the morning for different things like tumours on their face, on their legs, made me want health care to be free for all. People told me it couldn’t be done, but I came to Canada and health care is publicly funded! With that, there’s still issues but I believe in health care for all so, as a society, let’s do what we can to make it possible for every community. Ultimately, I wanted to be in a profession that provided medical assistance without me needing to be paid before; I just need my skills and the equipment or medications of course.”

Can you describe your work and volunteer experiences?
“My research work is keeping me busy right now, but I used to work as a health care aide (HCA) at a cardiac surgery unit after my Term 6 placement. I’ve also worked as an HCA at Bowview Manor (a long-term care centre) and have done research with people who have recently been discharged to ask what we can do to improve their hospitalization. I have volunteered with the Indigenous Student Access program as a mentor for two students. I am currently working in my preceptorship since it’s paid as a hybrid UNE in a rural setting. But, it is a new program that AHS is trying out.”

Can you talk about what you’ve learned from your work experiences?
“I’ve done a lot of things I’ve learned from. If anything, my biggest learning is in the way I live my life. So, I worked at the Ottawa Hospital as a research assistant where our research study focused on people with a poor prognosis, defined by survival limited to less than 12 months, and people with goals of care that can be translated to R1¹ in Alberta. The question was why choose R1, since if they survive, there will be much more hardship and ICU stays and the comorbidities are still there.

From conversations with these patients, I found I learned so much from them.

“One story that stayed with me was with this patient that had been putting off retirement for so long; he saved up for retirement at 65 [years of age] and retired at 70 to save even more. So, at 70, he finally makes a trip to this country he had always wanted to go to, and when he lands, he collapses. He comes back to find out he has a brain tumour and his prognosis is really poor. When he was telling me the story, he said ‘do not wait to enjoy your life: work hard, but still enjoy it. Don’t wait for when things are better or when you’re rich, because that might never happen.’ So that for me has affected the way I live my life. I try to have fun and still work hard but enjoy it.”

^{1Goal of Care that allows the patient to recieve cardiopulmonary resuscitation as indicated.}

Can you describe your preceptorship experience?
“So it is not a particular unit or specialty, it’s the whole hospital. Here in High Level, I believe we’re the northernmost hospital for AHS so we serve so many surrounding communities and reserves. We have a huge Indigenous and Mennonite population nearby, then you have everything in between, so we have a bit of everything. For the students and nurses, we get to work and do everything; that’s the way it is.

My preceptor works ER [emergency room], OR [operating room], L&D [labour and delivery], post-partum and acute care, so we are true generalists. If push comes to shove, we are the critical care team because there’s no code team. It’s just us. If a neonate requires resuscitation, we can’t fly them out to Edmonton or Grand Prairie immediately. We have to stabilize them before flying them out. If there’s an emergency or if someone comes in with a brain bleed, we have to figure it out. We’re the ECG techs, we’re the urinalysis lab team. If you are not sure where you want to specialize in nursing, this is perfect for you as well.”

Have you seen any challenges with being in a rural setting?
“There definitely are some challenges. I think the biggest for me is lack of access to resources for the truly remote and isolated communities. I wonder how good the public health is for a patient that is flown to High Level and then back to their remote community. What does continuity of care look like for these folks? For some of these communities, you can’t access them until the ice roads are built…imagine having to wait until nature helps build a road for you to travel on.”

How did you begin your research experience?
“It started in Term 5, in Dr. Kara Sealock’s class when we were learning about petechiae. I saw the pictures on the presentation, with those bright red pinpoint marks and thought to myself 'what would that look like on really dark skin?' So, I went to Kara’s office to propose if we can work with the hospitals and clinics across the world and ask them to take pictures to catalogue various conditions, and she said 'so you want to do a PhD?'

We focused on something that is more manageable, like IV starts, since our textbooks say people with dark skin have difficult starts. I said, 'that’s fantastic because my sister is a nurse and I have never heard her complain about the difficulty in starting an IV because she works in Nigeria where everyone has dark skin, so how are they doing it down there that is different from here?

I submitted the PURE funding [application] for eight weeks, and thankfully got approved early this year. The project for the summer was creating a standardized nursing guide to show how to teach IV initiation. I wanted to focus on palpating a vein and what it feels like, because in dark skin, you can’t really see those green or blue colours. You have to focus on feeling it or even finding it under the skin and bringing it to the surface if the person is dehydrated, there’s edema or burns. We also created a video to support that, and a survey for the first few cohorts to provide us with feedback on the resources.”

What were your intentions in starting this project?
“The reason was for representation. My goal for this was not just about the IV. I wanted to highlight the nuances of clinical manifestations based on skin pigmentation. I had an interaction with a patient who had phlebitis on their dark skin, and it did not look bright red. We cannot translate something like petechiae, or a malar rash, or a pressure ulcer to look the exact same on patients with different skin tones, and although we might not have the pictures, at least we can put this awareness in people’s minds. Hopefully more people will do more work to catalogue pictures for health-care professionals.”

Can you tell me about your work with the Scholar’s Academy on this initiative?
“With the Scholar’s Academy, I am trying to see if we can ask Google to make their search results more diverse and inclusive. When I search up 'acne' I don’t want to see only people with white skin. When you Google 'pressure ulcer dark skin,' the options are scant, so I don’t blame Google for instances where the pictures are just unavailable. But for things like acne which are well researched, these pictures are out there for various ethnicities, so why can’t we diversify the results? I am getting some people from the Scholar’s Academy to help me speak in a language Google will understand since I don’t know anything about software or the company."

Can you please describe your research work regarding psychiatric health teaching?
“It started with Michelle [Cullen]’s lecture in Term 5, where she mentioned psychiatric patients in general units are more likely to have restraints used against them. I got curious about why and realized general nurses are not trained in the same way to de-escalate patients that psychiatric nurses are. Is this fair for the patients? No. Also, from my personal experiences with violence from patients, I realized I don’t know what to do in those situations, especially considering I’m a mature student with a previous degree. Imagine new high school graduates having to speak up to their patients like that - they don’t have that authority developed.

Thankfully, Michelle was keen on this project as well. So, we applied for the Taylor Institute Development and Innovation grant for two years to develop a virtual simulation. We decided on this modality so students can learn in a safe space and have time to think about their response. Although there are limitations to virtual simulations, we wanted something that was sustainable.

The virtual simulation will present scenarios to help students think; what would I do if a patient says sexually suggestive things to me or if a patient says they want to hurt me? This allows them to think, this is what I can say and do in an empathetic, yet firm way and reflect on their approach afterwards. Nurses don’t want to be abused but it’s like we have to learn to deal with it, which leads to burnout, poor retention rates, and poor mental health. It’s a cycle of chaos, so with this, the faculty is taking a step to support its students and I hope other organizations and the government will do the same.”

Any final words about your research projects?
“Research is a lot of fun, yet the power and importance of research often goes overlooked. Nursing is great, but I would like to eradicate the need of health-care professionals like nurses, physicians, and dentists. I’m an idealist. I believe in prevention. How can we create healthier communities? In my internal medicine rotation, it seemed every patient had sepsis, and I wanted to know what was making sepsis so prevalent? I hope student nurses and registered nurses will start putting those pieces together, such as why are patients coming in with acute chronic obstructive pulmonary disease (COPD) exacerbations, why are my patients in with decompensated heart failure?"

"I want more nurses to consider joining research to think about how we can create healthier societies rather than just treatment. In Nigeria, we used to say, prevention is better than a cure. So that’s my big interest in research.”

Moving to your nursing school experience, can you describe your favourite course you’ve taken?
“My favourite course has to be NURS 288 because I enjoyed learning about how to support healthier communities. I really like community nursing, and one of my favourite things about that class was learning how to communicate with community members. We can’t go to these communities and say we’ll fix them.

I traveled to Nigeria after Term 3 and went to my community where I was hoping to start a clinic eventually after I complete my nursing education. When I went, I did exactly what we were taught to do and spoke to locals to propose my idea to start a clinic. They said 'that’s a great idea, but no need, because you can build a clinic, but there will be no road to travel there.' They explained to me the importance of the road, and how we have a high maternal mortality because people can’t get to our basic health centre in time. So, you could have the best hospital or clinic, but if people can’t get there, including the patients, physicians, and nurses, there’s no point. Learning what is most important to a community will help in supporting them."

How do you think you have changed since starting nursing?
“I think I’ve undergone a significant shift in my approach to understanding people and their challenges. I've become more attuned to the social determinants of health and how they influence individual choices and circumstances. I no longer attribute decisions solely to personal factors.

Instead, I approach each situation with a nursing mindset, considering an individuals’ backgrounds, socioeconomic status, and the context in which they make choices. This change in perspective isn't limited to patient care; it extends to my interactions with all people, allowing me to better comprehend how various factors impact people’s decision-making processes.”

Can you describe your best memory of nursing school?
“On the first day of my preceptorship, a labouring mom was starting to push. She had already given birth seven times, so my preceptor went to call the doctor, but before she could even finish the call, I was like, 'I can see the head,' next thing I know, I’m catching this baby. My first baby.”

Who would you say is your biggest role model?
“My biggest role model is the late Dr. Paul Farmer. He started a clinic in Haiti and focuses on making communities self-sustainable instead of going to help people and then leave. He worked with the community to establish a medical school to build long-term healthcare capacity in Haiti.

That’s what I hope to do around the world. We might not be able to build a hospital in every community, but if we train community health workers, we might be able to have communities that can provide basic life support. By investing in long-term sustainability, we can perhaps address health disparities in isolated communities.”

What do you do for self care?
“I watch Korean dramas, anime, I eat and sleep. I also talk to family and friends.”

Do you have any final words you would like to end on?
"My main motivation, which I try to remember everyday, is to not give up. I have this quote for my daily practice, 'even if I know that tomorrow the world is going to pieces, I will still plant my apple tree.'

When you have a passion like I do, to make this world a better place, and you see evil all around, you see people that want things to stay the way they are, it demoralizes you. It makes you think there is no point in trying. I keep thinking to myself, 'let me plant my apple tree and hopefully it bears fruit.' 

I hope for the opportunity, at some point in my life, to make a meaningful contribution towards alleviating human suffering. Hopefully, I can contribute to making our world a bit more fair, just, and equitable wherein everybody, every child, every family, has access to good food, clothing, shelter, education, health care and much more.”