July 6, 2020

Class of 2020: Nursing master's grad explores nurses' roles with vulnerable opioid-impacted populations

Addictions and harm reduction nurse Carlina Cavelti Schmidt was part of team behind safe opioid treatment clinic in Calgary

Carlina Cavelti Schmidt knew that someday she would have a career in health care. Caring for others has always been a large part of her personality.

She completed her Bachelor of Science in Nursing from Lipscomb University in Nashville, Tenn. in 2013 and started her nursing career in preventive health. Two years later, she moved to Calgary and was offered a job in mental health. At first, Cavelti Schmidt was tentative, as she was unfamiliar with this area of nursing. She worked at the Short Stay Psychiatry Unit at the Peter Lougheed Centre and then at the Crisis Stabilization Unit at Rockyview General Hospital, where she encountered patients with alcohol and drug addictions.

As she began transitioning her career focus toward addictions and harm reduction, she saw that nurses she worked with had more education, comfort and consistency with how they treated patients with alcohol withdrawal than with opioids. Something inside of her came alive.

She recognized nurses educated at an advanced practice level are needed to continue evolving the practice of nursing, to push boundaries and show diverse ways nurses can be utilized to better the health-care system. Cavelti Schmidt also wanted to learn research skills to make credible inquiries about nurses’ roles in opioid withdrawal and their experience in using the Clinical Opioid Withdrawal Scale.

Carlina Cavelti Schmidt, MN'20

Cavelti Schmidt was the first UCalgary MN student to defend thesis using virtual Zoom platform.

In September 2017, Cavelti Schmidt entered the UCalgary Master of Nursing (MN) program. And in April 2020, during the COVID-19 pandemic, she successfully defended her thesis.

"I chose to do a thesis-based master's at UCalgary for many reasons. Attending in-person classes is how I learn best, and meeting and studying with peers from other realms of nursing brought perspective and added considerations for advance practice nursing. I chose the thesis route (rather than course-based) as I had a specific research topic in mind. My thesis is titled Nurses Experience of the Clinical Opioid Withdrawal Scale.

Cavelti Schmidt had an incredible experience during her two years of study. She says, “Master's programs can be isolating and are completely different than undergrad programs. You really have to make an effort to get together with your classmates or else you’ll spend two-plus years sitting at home alone writing papers in your own little research bubble.”

She credits her committee, Drs. Jacqueline Smith, PhD, Andrew Estefan, PhD, and Graham McCaffrey, PhD, for her success.

Cavelti Schmidt’s job ranges from medication management, wound care and point-of-care testing to 1:1 counselling as a response to overdoses.

Cavelti Schmidt’s job at the Calgary AHS iOAT (Injectable Opioid Agonist Treatment) Program ranges from medication management, wound care and point-of-care testing to 1:1 counselling as a response to overdoses.

Contributing to innovative new treatment program

Together with eight other RNs, Cavelti Schmidt helped establish the Calgary AHS iOAT (Injectable Opioid Agonist Treatment) Program which opened in October 2018. The iOAT program provides a safe supply of opioids to patients who go to the clinic three times a day to inject (provided by the clinic). They receive a long-acting opioid at their last session to keep them from experiencing withdrawal through the night. Patients also receive all their other scheduled daily medications at the clinic, which additionally provides help with funding (AISH, NIHB, AB Works), securing safe housing, psychosocial support and medical issues.

"Seeing clients three times a day, every day, really gives me a chance to connect with them,” says Cavelti Schmidt. “I joke that I see and spend more time with my patients than my own family. Some of the patients I’ve known from working on mental health units so it’s awesome to be able to follow a client for years.

It’s truly amazing to see clients who are so impacted by drug use, over the years, to engage in the iOAT program and have such success. I’ve seen a patient go from being hopeless, homeless and in a drug-induced psychosis to joining the iOAT program, attending three appointments a day, working small jobs and managing a household.

Nursing becomes part of the person

“Being part of the iOAT program has changed the way I view nursing,” Cavelti Schmidt explains. “You have to be very open-minded and creative to work with this population. What works for the average population might not for this marginalized group. Most of our clients have been unsuccessful in other programs because their needs have gone unmet and as a result have trust issues with the system.

"When someone presents to our program seeking help, we do our best to engage them right on the spot — instead of asking them to come back in, say, three days — because right there that’s saying ‘No’ to someone who has heard that word a lot in their lives.

"Nursing is now a part of who I am — the things I learn and do at work directly impact my life and my outlook on the world. I get excited going to work. I love the interactions I have with patients and the new things I learn every day. When you find something you love doing... it doesn’t feel like work."

Completing the master’s program has directly impacted how Cavelti Schmidt thinks as a nurse and the care she provides. “After working in the field for five years, now I feel like an expert and the master’s program, having the MN behind my name, gives me added credibility to be a nurse leader. "

Cavelti Schmidt says her goal is to be an advocate for patients and policy change to ensure evidence-based practices will inform and be the basis of the care nurses provide to the vulnerable opioid-impacted population.