USU Psych Mental Health Nurse Practitioner Students Participate in Unique At-Sea Clinical Rotation

USU Graduate School of Nursing students had the unique opportunity for a clinical rotation aboard the USS Paul Ignatius (DDG 117).  (Credit: U.S. Navy photo)

By Vivian Mason


Two miles offshore of Naval Station Mayport, Florida, near Jacksonville, Army Capt. Ryan Parry and Navy Lt. Nicole Barthelme, both second-year Psychiatric Mental Health Nurse Practitioner Program students at the Daniel K. Inouye Graduate School of Nursing at USU, were aboard the USS Paul Ignatius (DDG-117), a U.S. Navy destroyer. Their mission? To administer mental health support to heavily stressed crewmates during a four-day period.

Navy Lt. Nicole Barthelme and Army Capt. Ryan Parry, psychiatric mental health nurse practitioner students at the Uniformed Services University, completed a clinical rotation on the  USS Paul Ignatius. (Credit: Lt. Col. Brent Donmoyer, USU Graduate School of Nursing)
Navy Lt. Nicole Barthelme and Army Capt. Ryan Parry,
psychiatric mental health nurse practitioner students at 
USU, completed a clinical rotation on the USS Paul
Ignatius. (Credit: Lt. Col. Brent Donmoyer, USU GSN)
Their program preceptor at the Naval Hospital Jacksonville, Cmdr. Colby O’Quin, arranged the at-sea opportunity for the pair. O’Quin secured the unique operational experience for the students through Lt. Cmdr. Philip Yam, a psychiatrist at the Naval Surface Force Atlantic Medical Readiness Division Detachment Mayport, as part of their clinical rotation.  

“Most of the clinical encounters were done in a small classroom, but they also took place on the medical deck and in small offices throughout the ship,” says Parry. “We ‘deck-plated’ at some point throughout each day, which was walking around the ship and asking sailors about their mental challenges. It made me feel like a goodwill ambassador.” 

Even when they weren’t actively seeing patients, Parry adds that “deck-plating” allowed them to get a feel for how the crew was doing. “Sometimes,” he says, “Lt. Barthelme and I were able to offer on-the-spot coping skills or suggest making appointments with us. We met a lot of people that way.” 

“One evening,”says Barthelme, “Capt. Parry and I had the opportunity to serve dinner to the crew, which allowed us to see and talk with a lot of the Sailors. They seemed genuinely happy to have us there.”  

Throughout their time onboard, they let everyone know that they were available to see individuals one on one. They also encouraged anyone who might know someone who was struggling with any mental health concerns to come see them or just come and talk. 

“Each day we worked with Medical,” recalls Barthelme. “They helped us set up appointments so that the crew could come see us for any mental health needs.” During sessions with the crew, Barthelme and Parry offered coping and relaxation skills, initiated medication as needed, completed safety risk assessments, engaged in safety planning, and scheduled follow-up appointments. 

Parry gave classes on stress management, and Barthelme gave interactive classes on anger management to extend their reach and support even further. These classes had more than 25 sailors per group, and these groups led to individual referrals to see a provider while on board. The two Psychiatric Mental Health Nurse Practitioner students also provided education to corpsmen on various mental health topics, including completing a suicide risk assessment and a safety plan. As word continued to spread about their onboard presence, more and more referrals came their way. By the end of their experience, they had seen about 20 patients. 

As a means to help bond with the crew while on clinical rotation, Army Capt. Ryan Parry and Navy Lt. Nicole Barthelme serve dinner to the crew. (Credit: Lt. Col. Brent Donmoyer, USU GSN)
As a means to help bond with the crew while on clinical
rotation, Army Capt. Ryan Parry and Navy Lt. Nicole
Barthelme serve dinner to the crew. (Credit: Lt. Col. Brent
Donmoyer, USU GSN)
“These highly motivated Sailors work hard each day to defend freedom and democracy around the world, but it comes at a cost,” says Barthelme. “They spend large amounts of time away from family and friends, work long hours, stand watch at all hours of the day and night, obtain their ship qualifications, and experience significant stressors that those of us not assigned to a ship couldn’t fully begin to understand.” 

Parry agrees, noting how his time on the ship was both “challenging” and “eye-opening.” 

“It gave me a better understanding of how the Sailors lived,” he adds. “When you’re living in austere conditions and operating on very little sleep, it takes a lot out of you. What amazes me is the ongoing resilience of these Sailors. They’re performing such technically skillful jobs while living in conditions away from land and creature comforts. It was challenging to get an understanding of that.”  

In addition to Parry and Barthelme, the ship always has a corpsman on board who is trained to do psychiatric assessments and to take care of the Sailors. A military chaplain is available for counseling and guidance. Between them, the two Navy staff members handle all behavioral health issues. When the ship is back in port, there is also a psychologist and a psychiatrist readily available through the Naval Surface Force Atlantic Medical Readiness Division Detachment Mayport.

Despite the inherent challenges, Barthelme says she was incredibly excited by the prospect of working on a ship,  as it was something she had wanted to do since she joined the Navy. Like Parry, Barthelme described the cramped quarters and time spent learning about the various jobs on the ship as “eye-opening.” 

“I enjoyed spending time on the bridge [the ship’s command area],” concludes Barthelme, “experiencing the customs and courtesies of eating in the wardroom [officer’s dining area], stumbling through the P-ways [passageways], and using exercise equipment while enduring the pitching and rolling from the ship’s course.” 

Parry and Barthelme say that by the end of each day, they were tired. To wind down, they generally went to the medical deck to play cards, relax, or just hang out. 

USU GSN students, Army Capt. Ryan Parry and Navy Lt. Nicole Barthelme took advantage of a unique opportunity for an at-sea clinical rotation aboard the USS Paul Ignatius. (Credit: Lt. Col. Brent Donmoyer, USU GSN)
USU GSN students, Army Capt. Ryan Parry and Navy Lt.
Nicole Barthelme took advantage of a unique opportunity
for an at-sea clinical rotation aboard the USS Paul Ignatius.
(Credit: Lt. Col. Brent Donmoyer, USU GSN)
“When you finally go to bed,” Parry says, “there’s a metal wall that separates you from the person on the other side. Well, my neighbor kept rolling and hitting the metal wall. At least once an hour, there was an alarm clock going off for someone to perform watch duty. Then, overhead announcements kept coming on, as well as the ship alarms that went off. It made it difficult to sleep. You can read about sleeping in a bunk that is short and narrow, but until you’re in there and realize that you can barely move on your side, you just don’t understand it.”

Overall, Parry says this experience reinforced what he loves most about nursing: the ability to have a direct and positive impact on someone’s life, and the USU psychiatric mental health nurse practitioner program has allowed him to do that. 

“I’m a far more knowledgeable and comprehensive caregiver,” Parry explains. “I’m able to look at the person with a greater depth of knowledge and can be more analytical when looking at their issues.”

Barthelme, whose mother is a nurse, always wanted to help people and make a difference in their daily lives. This uniquely USU experience made her a better caregiver, providing Barthelme with the knowledge of how to “look at the person as a whole and gain a deeper understanding of the issues that resulted in that individual seeking care and providing that care accordingly.”

Following their experience aboard the USS Paul Ignatius, Barthelme says she wants to make a career out of the Navy and will be going to Camp Lejeune in a few months.  Parry says he plans on spending the next eight years in the military, going “wherever the need is.” 

Both nurses believe the shipboard rotation was an invaluable learning experience, as well as a way to help gain an understanding of the stresses at sea. 

In Parry the soldier’s mind, the choice is simple: “If you ever have the opportunity to serve on a ship, take it. The growth is worth the journey.”