Interesting article.
Arizona RN practices nursing on the trail with at-risk youth
Debbie Merrell, RN, loved her work as an intensive care and critical care nurse, but after more than 20 years on the job, she was burned out and ready to leave the profession altogether. An employment counselor at her church steered her towards a different kind of nursing — at an Arizona wilderness behavior therapy program for at-risk youth and young adults. The nurses' duties included hiking through the rugged Tonto National Forest with a heavy pack, sometimes at night, sleeping on the ground without a pad and the occasional wild animal confrontation.
No way, Merrell said. "I'd never hiked a day in my life, never camped. Camping for me was going to a hotel, sitting in the Jacuzzi," says Merrell, 52.
Merrell did agree to help out the ANASAZI Foundation as a consultant. She went to the organization's offices in Mesa, Ariz., to learn about the program, and she endued up taking the job. "I got hooked," she says. "I never thought I could work with teenagers. I fell in love with the kids."
The foundation borrows from Native American traditions focusing on the healing aspects of nature to treat youth and young adults ages 13 to 25 with substance abuse issues, psychiatric disorders and learning disabilities. At ANASAZI, it's all about the wilderness and walking — 42 days of it, minimum. In small groups with guides, participants hike up to 10 miles a day, carrying minimal, low-tech gear, learning to cook their own food and build shelters to protect themselves from the elements.
At a cost of $455 a day, the treatment program requires a significant financial and time commitment from parents, who attend a 12-hour educational seminar and usually spend two nights on the trail with their child.
ANASAZI has no particular religious affiliation, but the program emphasizes spirituality, and has its own mystical-sounding lexicon: Participants are called "youngwalkers," counselors are "shadows" and group leaders are "trailwalkers." Everyone receives a new trail name, such as Merrell's: "Beautiful Morning Lioness."
Unfamiliar terms and names, says Merrell, are free from stigma. "What we don't want is labels or judgment. It's a new beginning. Youngwalkers are learning to walk again, stand on their own two feet."
Before youngwalkers head into the wilderness, their first stop is to see Merrell, who does an intensive physical and emotional assessment. "Not just blood pressure," she says, "but really in-depth questions about drug use, sexual history, if they cut themselves, ever attempted suicide, sexual abuse."
Merrell, along with staff psychologists, closely monitor the youngwalkers through radio communication with group leaders. Once a week Merrell and a counselor drive four to six hours over rough dirt roads, strap on their packs and start hiking to catch up with the 20 to 40 participants out on the trail. Merrell checks in about nutrition and hygiene, and treats minor cuts and sprains. She's on call for emergencies, and has gone into the field to treat a range of more serious issues — dehydration, wounds requiring stitches and hypothermia. Occasionally a situation requires evacuation. Recently, one of the youngwalkers tripped and fell, impaling his hand on a knife blade. Merrell was there to stabilize his hand and get him to the nearest hospital.
While the program is physically and emotionally rigorous, ANASAZI stresses that it is no "boot camp." No one is forced to stay — if a youngwalker runs away, says Merrell, trailwalkers will simply follow behind to ensure safety and offer companionship. There are no special privileges afforded to staff, who walk the trail with the same gear and food. That means no sleeping pad, no chairs and no shirts with logos or slogans.
Merrell not only had to learn wilderness survival skills for her job, she had to re-focus her nursing skills. "Wilderness nursing is different than having everything accessible in the hospital or ER," she says.
While Merrell is now a certified wilderness EMT, she still relies heavily on one old-fashioned nursing skill: TLC. "Sometimes the youngwalkers just need a shoulder to cry on, or a hug," says Merrell, who has two teenage children. "They are missing their parents, even if they won't admit it."
Robert Hampton, a 21-year-old audio engineer from Los Angeles who was a youngwalker last year, agrees. "Nurse Debbie was very easy to talk to, very comforting," he says. "It was like having a mother on the trail. She brought hot sauce and tea packages. The food packs are pretty bland. When you're out there, hot sauce and tea makes a difference."
In five years on the job, Merrell's biggest challenge has been the time commitment. As the only staff nurse, she was on call 24-7 and had to be within phone range even on vacation. Recently ANASAZI hired another nurse, and now Merrell shares call, two weeks on, two weeks off.
"It's so rewarding being around so many wonderful kids. I can't see myself doing anything else," she says "I get dirty, smelly, smoky, I get wet. You see all kinds of animals. Mountain lions, bobcats. I had a three-pound lizard jump on my back and crawl onto my head. It's always an adventure."
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