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THE MAGA ZINE OF COLUMBIA UNIVERSIT Y SCHOOL OF NURSING

NEW HEIGHTS: DNPs SHARE THEIR STORIES

BEHIND THE NUMBERS: REDUCING RATES OF HOSPITAL INFECTION

TRANSGENDER HEALTH

Contents

Spring 2014 The Academic Nurse Vol 31. No 1 The Academic Nurse is the magazine of Columbia University School of Nursing and is published twice a year

Columbia University School of Nursing

Bobbie Berkowitz, PhD, RN, FAAN Dean, Columbia University School of Nursing Mary O’Neill Mundinger Professor of Nursing Senior Vice President, Columbia University Medical Center

Produced by the Office of Strategic Communications & Marketing Marc Kaplan Associate Dean, Strategic Communications and Marketing Rachel Zuckerman Senior Digital Strategist Managing Editor Lisa Rapaport Senior Communications Specialist Alumni News Editors Reva Feinstein, MPA Associate Dean, Development and Alumni Relations Janice Rafferty Director of Development Janine Handfus Associate Director, Annual Fund and Foundation Relations Mairead Moore Assistant Director, Alumni Relations

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Contributing Writers Robert Brown Stacey Harris Andrea Kott J. Duncan Moore Photography Monika Graff Design and Art Direction Matthias Blonski Cover Illustration Davide Bonazzi Please address all correspondence to: Info.nursing @columbia.edu

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Letter from the Dean

Research Roundup

A Decade of DNP

Walter Bockting: Exploring Transgender Health on its Own Terms To Stop Hospital Infections, Start at the Top

School News

Class and Program Notes

Board of Visitors

In Memoriam

Then and Now

Alumni are invited to update their contact information by emailing nursingalumni@columbia.edu or calling 800-899-6728

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From the Dean

The American public has placed significant trust in our profession. I believe we, as nurses, have a compact with society to keep its members safe when they are in our care; and society expects us to do so. But what exactly does that mean, to keep one safe? It is one of our most important roles along with promoting health, managing symptoms of illness and distress, and advocating for a more just, progressive, and prosperous society. I consider earning and maintaining the public’s trust through our roles as educators, scientists, and clinicians as our most important mission as a school of nursing. I think about how to gain the trust of our current students, future students, and our alumni in our ability to assure that the future of health care is aligned with the hallmarks of excellence in all that we do, particularly in relation to our role as clinicians. Therefore, this issue of The Academic Nurse features three themes which constitute the essence of our work as a trusted profession: advancedpractice education that is changing the face of the health care system; research which points the way toward eliminating costly, deadly, and persistent health care problems; and new insights and perspectives on meeting the needs of an underserved population. A decade has passed since we established the Doctor of Nursing Practice program at Columbia Nursing. With its challenging, comprehensive curriculum, the DNP degree represents the pinnacle of advanced education for professional nurses. Those who’ve earned it acquire extensive clinical knowledge and skills anchored in evidence. And they gain insights for use every day in their practices. As health care reform brings nurses to the forefront of increasingly complex care delivery and management of chronic illness, DNP-prepared nurses are leading the transformation of the American health care system. We’re doing so by working to ensure that health care is cost-effective, of high quality, and promotes the well-being of entire populations.

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We honor the DNP decade at Columbia Nursing by introducing you to three extraordinary graduates of our program. You’ll hear from a chief nurse anesthetist at a world-class cancer hospital, a distinguished nurse educator and champion of nurse education on a global scale, and a dedicated family nurse practitioner who delivers outstanding care to patients in a Denver suburb. All three describe how their DNP degree empowers them to make real and sustained differences in the lives of the people they serve, while opening doors to opportunities for fulfilling professional and personal goals. You’ll also be introduced to the perspective and experiences of a current Columbia Nursing DNP student. Our DNP program prepares nurses to apply the latest research advances to their practice, whether at the bedside or in a community setting. For example, Patricia Stone, PhD, RN, FAAN, director of our Center for Health Policy and Centennial Professor of Health Policy in Nursing, has investigated health care-acquired infection (HAI) rates at almost 1,000 hospitals. HAIs are one of the most widespread and intractable problems in our field, which the Centers for Disease Control and Prevention estimate affect one of every 20 hospitalized patients every day, causing or contributing to 99,000 deaths each year. Stone and her colleagues found that many hospitals are slow to adapt demonstrated best practices for curbing HAIs as well as fail to comply with their own HAI-reduction policies already in place. “To Stop Hospital Infections, Start at the Top,” looks behind the numbers to show how we can do a better job of reducing these often preventable and life-threatening scourges.

(LGBT) communities, particularly where stigma and discrimination have reduced access to high quality and affordable care. In 2010, I served on an Institute of Medicine consensus committee that examined the health of LGBT populations. Our report assessed the state of science of LGBT health, identified research gaps and opportunities, and outlined an agenda for the National Institutes of Health with recommendations on research priorities for improving LGBT health. Through my work on the committee I had the pleasure of meeting Walter Bockting, PhD, a global expert on LGBT health. Our committee completed its work in 2011, but Walter and I kept in touch. To my delight, he joined our faculty and that of the College of Physicians and Surgeons in a joint appointment. As co-director of our LGBT Health Initiative, he is continuing his groundbreaking work on transgender health by helping develop evidence for effective care for this often underserved population. “Walter Bockting: Exploring Transgender Health on its Own Terms,” will introduce you to a health care pioneer and perhaps a new way of thinking about the transgender population. The three areas explored in this issue have been at the heart of our mission for decades. Through the work of extraordinary members of the Columbia Nursing family, they are being revitalized for the 21st century. Let them serve as an inspiration to us all!

Bobbie Berkowitz, PhD, RN, FAAN Dean, Columbia University School of Nursing Mary O’Neill Mundinger Professor of Nursing Senior Vice President, Columbia University Medical Center

Nursing has a long and honorable tradition of delivering care to underserved and vulnerable populations irrespective of economic, ethnic, social, or cultural determinants. Many obstacles to providing such care still confront our profession and we remain as dedicated in our resolve to address them as ever. For example, nursing today is a leading advocate for the health of the lesbian, gay, bisexual, and transgender

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A New Way to Look at Health Information Pg. 08

With Increasing Reliance on LowerPaid Nurses, China Risks a Revolving Door of Care Pg. 10 Improving Care in the Crowded ED: What Nurses Can Do Pg. 11

Menstrual Problems a Key Predictor of Emotional Health in Women with PCOS Pg. 12

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More than a dozen states have passed legislation expanding the role of nurse practitioners (NPs) to help fill the shortage of primary care providers in the U.S. But despite such legislation, NPs still face hurdles in organizational culture that undermine these policy changes. That’s what a research team led by Lusine Poghosyan, PhD, MPH, RN, assistant professor at Columbia Nursing, found when it investigated how workplace environment affects NPs’ ability to practice autonomously and deliver quality care. Results of the study were recently published in the Journal of Professional Nursing. Because Massachusetts was the first state to recognize NPs as primary care providers, it was an ideal place to study their workplace experiences. The results suggest that legislative reform did not immediately translate into practice.

A q u ic k lo o k a t s om e rec ent res ea rc h devel opments at C ol umbi a U ni vers i ty S chool of Nursi ng

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Scope of Practice Legislation: Necessary but Not Sufficient for Workplace Empowerment

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Poghosyan looked at the levels of support and resources available to NPs, who reported in interviews that they often felt excluded from decision-making. They also felt invisible to administrative staff, who poorly understood their roles and contributions to patient care. Further, they felt stymied by insufficient access to personnel support and operational resources such as adequate exam-room space. The study also cited instances where NPs were not allowed to see new patients or even conduct physical assessments. NPs often did

Organizational policies can prevent nurse practitioners from making a full contribution to patient care.

not achieve greater autonomy to see new patients, prescribe medications, conduct physical assessments, or order diagnostic tests. These findings have repercussions beyond Massachusetts. With a surge of newly insured patients under the Affordable Care Act, demand for primary care services will increase nationally. At the same time, an aging population— living longer with more diseases— is also heavily relying on primary care providers. Says Poghosyan, “Organizational policies often trump government policies by precluding NPs’ making a full contribution to effective patient care. This kind of climate will not help our nation’s primary care-provider shortage, nor will it enhance patient care.” While legislation to create a legal framework for NPs to practice independently is a good first step, health care organizations need to establish internal policies conducive to effective NP practice. For example, administrators should clearly define ways for NPs to be included on the decisionmaking committees that govern the daily operations of the health care workplace.”

Some progress has been made in improving the conditions of NPs in the primary care setting, according to the study. The longer NPs worked with physicians, the more the physicians trusted them and promoted their autonomy to practice independently. This extended to administrators, who had better knowledge about NP roles and abilities once they had experience working with them. “If familiarity encourages greater professional recognition and appreciation of NPs,” says Poghosyan, “then meaningful changes in the workplace climate should be put in place quickly to fully capitalize on the potential for NPs to help meet the demand for effective primary care.” There are currently 55,000 NPs providing primary services in the United States; in the next decade those numbers are expected to jump to 244,000. Enacting policies that allow NPs to practice to the full scope of their education can go a long way toward enhancing patient care.

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research roundup 1

Research Roundup

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Scope of Practice Legislation: Necessary but Not Sufficient for Workplace Empowerment Pg. 07

research roundup 2

A New Way to Look at Health Information The use of imagery can help reduce knowledge gaps and help educators better deliver health information to communities with lower levels of health literacy. But there are no uniform visual models in use that are tailored to the needs of individuals with varying degrees of comprehension. In the first phase of a study led by Suzanne Bakken, PhD, RN, FAAN, FACMI, the Alumni Professor of Nursing and professor of biomedical informatics, researchers explored methods for designing and evaluating the effectiveness of innovative visual images— “infographics” —to convey health status and health behaviors. These methods will ultimately be tested among residents of New York City’s Washington Heights and Inwood neighborhoods who participated in a community survey that generated these data, as part of a large interdisciplinary research project called WICER: Washington Heights/ Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research. (WICER, whose goal is to understand the health of the community in order to improve its health, was funded by the Agency for Healthcare Research and Quality.) Bakken and colleagues, as well as trainees from Columbia Nursing and Columbia’s Department of Biomedical Informatics, developed a number of design models, 08

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Top: Blood pressure is displayed using a stoplight analogy. Bottom: Blood pressure shown on a pair of reference range number lines. The graphic showing the risks of high blood pressure provides additional context.

including block charts, icon bar charts, reference range number lines, and analogy-based graphics. For example, an effective analogy graphic is a stoplight using the red, yellow, and green lights to convey reference ranges for blood pressure. Another image, of batteries, offers individuals a visual way to assess their energy levels. Multiple versions of the designs were created, varying in color, direction (horizontal vs. vertical), and icon images. One innovative design featured a four-leaf clover to depict a person’s overall health status, with each leaf representing a different aspect of health such as nutrition, physical activity, sleep/energy, and mental health. The varying sizes of the leaves can help show the need for, say, more sleep or better nutrition. The researchers used images to outline and measure several goals, such as body mass index and blood pressure. Other images track a person’s health behaviors, such as the number of vegetable servings eaten and frequency of exercise, as well as changes in physical and emotional health. The graphics also show how an individual’s health behaviors and status compare with others of similar age and gender. Adriana Arcia, PhD, RN, postdoctoral trainee on the Reducing Health Disparities Through Informatics training grant, was first author of a paper describing the methods that the WICER team used to develop the infographics. “Method for the Development of Data Visualizations for Community Members with Varying Levels of Health Literacy” was presented at the annual symposium of the American Medical Informatics Association (AMIA). It won the AMIA’s prestigious Harriet H. Werley Award, which recognizes the paper making the greatest contribution to advance the field of nursing informatics. The challenge for health educators has long been to establish better methods of reaching individuals who, for a variety of reasons—whether because of education or language barriers—have difficulty understanding

The Academic Nurse

A clover leaf analogy helps to communicate imbalances that affect overall health status.

information about disease prevention, management, and treatment. This limited knowledge affects their ability to make informed health decisions. “Understanding health information is critical to improving the health of individuals,” says Arcia. “In most cases, those with lower health literacy tend to have poorer outcomes for chronic yet mostly manageable conditions such as diabetes and hypertension. And people with limited comprehension are less likely to benefit from public health education initiatives. At the same time, they are among the highest-risk populations for illnesses that would most benefit from an understanding of preventative health measures. That’s been a major public health challenge to health educators and one we hope this study helps to mitigate,” says Arcia.

These individuals also disproportionately live in poorer neighborhoods, contributing to the nation’s growing health inequity. According to a study by the John D. and Catherine T. MacArthur Foundation, adults with lower socioeconomic status are more likely to experience high blood pressure, obesity, heart disease, infectious diseases, and premature death. Low or marginal health literacy affects approximately 46 percent of Americans, who are more likely to have trouble taking medication as prescribed and managing their health through good nutrition and exercise. People with low health literacy also use more health care resources, including emergency room visits and hospital admissions.

Subsequent phases of the Columbia team’s work on infographics will measure the efficacy of various visual designs at supporting comprehension, compared with text alone, and will determine whether specific illustrations influence and encourage changes in health behaviors and ultimately health outcomes. This work is funded by the follow-on grant to WICER entitled WICER 4 U, which is also funded by the Agency for Healthcare Research and Quality, and is aimed at facilitating use of the WICER data by a variety of stakeholders, including community residents, community-based organizations, researchers, and health care providers.

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Nurses have long believed that patients treated in crowded emergency departments (EDs) are more likely to experience setbacks than patients treated during slower, calmer periods. Eileen Carter, RN, who left work as a full-time ED nurse to pursue a PhD at Columbia Nursing, was determined to better understand the relationship between crowded EDs and patient care and what nurses can do to improve the situation for patients.

With Increasing Reliance on Lower-Paid Nurses, China Risks a Revolving Door of Care For decades, nurses in China enjoyed guaranteed employment for life. But those days are over. The country has recently undergone sweeping economic and health system reforms that have rolled back the number of these traditional nursing jobs, known as Bianzhi—or “iron rice bowl”—positions. Today, more than half of hospital-based nursing posts are filled by contract (Bianwai) nurses who do the same work for lower pay, fewer benefits, and less job security. A research team led by Jingjing Shang, PhD, RN, assistant professor at Columbia Nursing, examined the effects of the two-tiered nursing pay system on job dissatisfaction, staff turnover, and patient outcomes at 181 hospitals throughout China between 2008 and 2010.

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Shang found that contract nurses were more dissatisfied with their pay and benefits and more likely to leave than nurses with lifetime job security. The study, “Nurse Employment Contracts in Chinese Hospitals: Impact of Inequitable Benefit Structures on Nurse and Patient Satisfaction,” was recently published in the journal Human Resources for Health. “China’s rapidly changing labor practices combined with a brewing nursing shortage emphasize the importance of equal pay for equal work,” says Shang. “Otherwise, patient care is likely to suffer.” The use of contract nurses is expected to increase as China continues its evolution to a freemarket economy and demand for health care increases as a result of an aging population.

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Shang and her colleagues also found that contract nurses were more likely to be male, and significantly younger, less likely to be married and have children, had less nursing experience, and were less likely to have an advanced nursing degree. Contract nurses were also significantly more likely to express the intention to leave their current job within a year. With more than 1.3 billion people, China has the largest population in the world. Current nursing employment practices and limited opportunities for growth are causing many nurses to change occupations or migrate to other countries which, facing their own nursing shortages, are actively recruiting in China. “China urgently needs to address the inequalities in nursing compensation to stabilize the nurse workforce and improve the quality of care in hospitals,” Shang says.

Carter and her research team conducted a literature review— recently published in the Journal of Nursing Scholarship—that examined the effects of ED crowding on patient mortality and serious complications. She found several studies linking ED crowding to higher death rates, both in the hospital and after discharge. ED crowding was also associated with increased rates of patients leaving the ED without being seen, again confirming nurses’ experience.

to ensure that hand sanitizers and face masks are always available for clinicians and visitors. Similarly, some assign nurses solely to patients who are done with their emergency care and waiting to be sent home or admitted to the hospital. Even in such cases, problems remain. “We don’t have a uniform, nationwide standard to measure ED crowding,” Carter says. “There’s a patchwork of different measures that are used, which limits our ability to understand the full scope of the problem.” Each year, millions of Americans seek medical care at emergency departments—and the number grows annually. Also growing is the typical wait time; in many cases, patients go hours before being treated. “Clearly this is a serious public health issue,” says Elaine Larson, PhD, RN, FAAN, associate dean for research at Columbia Nursing and senior author of the study. “So many people seek care in our nation’s EDs, and these numbers are rising every year. We cannot provide and sustain the high level of care that patients deserve without enacting additional policies to ensure their safety.” Carter agrees. “We hope,” she says, “that as a result of our study more attention will be paid to this issue, and nurses will play a pivotal role in effecting system-wide changes.”

research roundup 4

research roundup 3

Improving Care in the Crowded ED: What Nurses Can Do

“In the ED, there is a culture of immediacy rather than an emphasis on thinking about how care provided will affect patients down the road,” says Carter. “The nature of ED work is to prioritize the sickest patients, which of course has to happen, but we need to think more about how best to care for those people who have been stabilized but still need medical attention.” One way is to systematically address areas that aren’t immediately life-threatening but can help improve long-term patient outcomes, such as infection control and discharge planning. Some hospitals prevent infections by assigning one person per shift The Academic Nurse

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Menstrual Problems a Key Predictor of Emotional Health in Women with PCOS

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Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in the United States, affecting 6-17 million women during their childbearing years. Symptoms include infertility, hirsutism (excess body hair), irregular menstrual cycles, and obesity. The condition has also been linked to a range of mental health problems including anxiety, depression, and eating disorders. Nancy E. Reame, PhD, RN, FAAN, Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion at Columbia Nursing, supervised a research project that set out to find the links between PCOS symptoms and specific mental health complications. The study, published in a recent issue of the Journal of Behavioral Health Services & Research, found that of all PCOS symptoms, menstrual problems was the strongest predictor for psychological distress. The study also found that body hair and menstrual problems most strongly predicted anxiety, while obesity was most strongly associated with hostility.

research roundup 5

“It isn’t a surprise to clinicians that physical symptoms such as infertility, excessive hair growth, and weight gain would be emotionally upsetting to patients,” says Professor Reame. “Our goal was to expand on these findings from previous studies by looking at the level of psychological distress caused by individual physical symptoms of PCOS. We believe this will provide clinicians with more precise information for identifying psychologically at-risk patients.” “When we compared PCOS patients with a sample of women in the general population, we found significantly higher correlations between all of the physical symptoms we evaluated and several psychological distress measures, particularly anxiety, depression, somatization, and interpersonal sensitivity,” says Judy G. McCook, PhD, RN, associate professor of nursing at East Tennessee State University and co-investigator. “But we found that distress caused by menstrual irregularities was by far the most significant, across-the-board predictor of emotional distress. But because menstrual problems are so common, their psychological impact may be overlooked or not fully addressed during clinical examinations.” Something all clinicians should keep in mind when treating PCOS patients.

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Nadia Elgoghail ’14 (right) participated in a medical mission in Cameroon this winter

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his year marks the tenth anniversary of the Doctor of Nursing Practice, or DNP, program at Columbia University School of Nursing. Columbia Nursing’s program was among the first in the nation, and in the years since it was established, DNP programs have proliferated at nursing schools across the nation. Columbia Nursing’s DNP focus is unique among these programs in its distinctive emphasis on comprehensive clinical care. “The DNP program at Columbia University School of Nursing is a terminal degree that prepares the advanced practice nurse with the knowledge and skills necessary for comprehensive care of patients across sites and over time,” says Susan Doyle-Lindrud, DNP, ANP, DCC, (’94 ’08), director of the DNP program. “The advanced practice nurse with a DNP degree is well positioned not only to manage the individual patient, but is also prepared to improve patient outcomes through translation of research into practice.” Not only has Columbia Nursing’s DNP program graduated a cadre of exceptional nurse leaders, it is changing the face of nursing for the 21st century by helping to revolutionize the way health care is delivered in this country and around the world. In honor of the DNP decade, The Academic Nurse asked three DNP graduates and a current DNP student to tell us what the DNP degree means to them and how it affects their ability to care for patients, families, and communities.

BY ROBERT BROWN

Revolution, Evolution, Solution: 14

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DAV I DE B ON A ZZI

A D E CAD E O F D NP AT C OLUMBIA NURS I NG The Academic Nurse

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Deanna Tolman ’11

DNP, Columbia University School of Nursing, 2005 MS, Nurse Midwifery, Columbia University School of Nursing, 1985 BSN, Nursing, City University of New York/Hunter-Bellevue School of Nursing, 1983 BA, History, University of Chicago, 1967

DNP, Columbia University School of Nursing, 2011 MS, Family Nurse Practitioner, University of Colorado Health Sciences Center, 2001 BSN, Nursing, University of Texas, Arlington, 1991

Jennifer Dohrn graduated with Columbia Nursing’s first DNP class, while she was on the faculty of the school, teaching courses in midwifery. Dohrn is Director of Columbia Nursing’s Office of Global Initiatives, a nursing officer for the ICAP Global Nurse Capacity Building Program at Mailman School of Public Health, and an assistant professor of nursing at Columbia University Nursing.

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rior to Columbia Nursing’s DNP, there was no established pathway for nurse clinicians to expand their expertise to the doctoral level. It made little sense to acquire a PhD—we are clinicians, not researchers. That’s the brilliance of the DNP: It provides a fantastic opportunity for nurse clinicians. “My current day-to-day responsibilities are very different from what I thought they would be when I enrolled in the program. At that time, I was primarily focused on midwifery, which remains at the heart of all I do. However, today, among other things, I build nursing capacity models for developing programs in other countries, specifically Sub-Saharan Africa. I knew the DNP would help me provide better care for patients, but I didn’t realize how important it would be for my global work. It establishes a higher level of credibility for me within traditionally hierarchical systems. Here everyone knows me as Jennifer, but in Africa I am known as Dr. Dohrn among ministers of health, physicians, and educators—and that opens doors. “My work in Africa is claiming the higher ground for nursing as we face regulatory

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issues and education issues. For example, we are working with a school in Malawi to set up a DNP program. They never heard of the DNP until we got there. Now we are working with 10 countries in Africa to transform nursing education. This is real progress. “Globalization has brought to the surface health issues that need to be addressed globally, and nurses have a central and critical role to play on the global stage. As educators, we need to open students’ eyes to their ethical responsibility to the world—that everyone’s life is of equal value as ours—and encourage them to make this a theme of their life’s work to address health inequities. Many countries struggle just to educate nurses to the bachelor’s level, while our school of nursing offers a seamless path all the way to the DNP. In many countries that’s a long challenging road, but we have the responsibility to support it everywhere. And as we do it here, it has a ripple effect that leads to a stronger, expanded role for nurses worldwide. “This is a critical, historical time for health care, and there’s an urgent need for nurses, especially nurses educated to the fullest extent possible, who are willing to fight for change. Sometimes we look at the world as having such huge problems, and it’s hard to know how to help. But we must choose to imagine a way forward, to acknowledge the obstacles but not be afraid to press ahead, even if just a few steps at a time. We are helping women and families flourish against unimaginable odds within the context of health care—and health affects so many other things for a life of quality, of course. The DNP prepared me for these challenges. “There’s so much to be done here and globally. It takes a lot of time, work, support, coordination, hope. But people need you, so you do these things with a full heart. If you can be of use to just one woman and her family, then that leads to helping a local community, and that leads to helping the global community.”

“Nurse practitioners have lobbied for years for the freedom to practice independently,” says Deanna Tolman, an independent family nurse practitioner who founded Head2Toe HealthCare in Aurora, CO. “In fact, given the inadequacies of our health care system, we have an ethical responsibility to pursue this freedom.” Tolman attended Columbia Nursing because “the program was directed toward clinical expertise and independent practice, both of which are important to me.”

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COURTESY OF DEANNA TOLMAN

Jennifer Dohrn ’85 ’05

earned my bachelor’s at age 37, worked in critical care for a while, then earned my master’s in nursing at age 47. But I soon realized that the master’s degree was insufficient. I did not feel ready to take care of patients the way I wanted to. Then I heard about the DNP program. I emailed Columbia Nursing, asking if I would have to relocate and if I could get tuition assistance. In the end, I had to spend only 10 months in New York, and I worked as a teaching assistant to help defray costs. “When I finished the DNP, I was 56 years old. I knew I wanted to open my own practice, and the DNP gave me the credentials to make that happen. In fact, while I was at Columbia Nursing I wrote a 50-page business plan, which I implemented when I returned home to Colorado. That led to my founding the Head2Toe Clinic in Aurora, an open-access clinic. We have a four-person staff working in an inexpensive 800-square-foot office. We serve about 1,400 patients: 20 percent uninsured, 40 percent receiving Medicaid, and the rest privately insured. “My first visits with patients are often 90 minutes long. That’s because DNP training taught me to be incredibly thorough—and you can’t achieve that if you’re seeing 10 patients an hour. I see pathology as an element of culture in my practice. Patients lose years of their lives to diseases because no one took time to listen to them about their problems. I don’t want to miss the important information, so I give them time. I may make less money, of course, but I won’t see more than eight to 12 patients a day. “You can’t always devote that much time to patients when you’re working for someone else’s practice. That’s one reason

nurse practitioners have lobbied for years for the freedom to practice independently. This issue has now become critical in light of the ongoing developments resulting from health care reform and the lack of universal affordable, accessible, high-quality health care. The nation would save health care dollars and increase access to primary care if nurse practitioners were empowered to bill under their own name, hold joint ownership of primary care practices, and establish their own independent practices. “Traditionally, nurse practitioners have deferred to physicians for direction regarding patient care. And many expect to always work as employees of physicians, because that is how nurse practitioners are often acculturated during their education. However, we need to think the way doctors think: We must see ourselves as potential owners of our own practices. “There is a definite aspect of faith in my work. I believe we are all children of God, all brothers and sisters. We have an obligation to each other. I am serving my brothers and sisters—and you can’t skimp on how you treat family. The quality of my service shouldn’t be determined by whether I can afford to spend appropriate time with patients or whether they have health insurance; that is immoral. Everyone should have health care and everyone should receive the best health care I can give them. The question is how to set up such a practice and keep it profitable. But we are proving it can be done. It’s not a matter of seeing more patients so as to make more money. It’s a matter of living up to the ethics of our profession and creating the best outcomes, the best service, built upon the privileges we’ve received.”

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Q&A: Philip Gyura ’14

Laura Ardizzone ’04 ’10

Philip Gyura recently completed his master’s degree in the Family Nurse Practitioner Program at Columbia Nursing and is now a first-year student in the DNP program. Gyura’s focus is on addiction medicine and adolescent sexual health. He anticipates earning his degree in summer 2015.

DNP, Columbia University School of Nursing, 2010 MS, Nurse Anesthesia, Columbia University School of Nursing, 2004 BSN, Nursing, University of Pennsylvania, 1999

What drew you to nursing as a career? “I knew I wanted to be a nurse going into my freshman year in college. What attracted me to nursing was its focus on compassionate care and the close relationships I could have with patients as a nurse. It was a perfect fit for my personality, my communication style, and my personal goals.”

Laura Ardizzone is chief nurse anesthetist at Memorial Sloan-Kettering Cancer Center, where she manages a team of about 60 nurse anesthetists working in more than 40 locations. She is also an elected member of the Board of Directors of the New York State Association of Nurse Anesthetists. Ardizzone was an assistant professor of clinical nursing at Columbia University School of Nursing from 2008 to 2012.

Why did you decide to pursue a DNP degree? “I am originally from Minnesota and worked at the Mayo Clinic for two years as an RN. I also worked a year in a detox center, where I was drawn to the needs of young adults. And I realized that I could better serve these people with a DNP degree.” Why did you choose Columbia University School of Nursing for your DNP? “Columbia Nursing was my ‘that’ll never happen’ application for graduate

school. I had been east of Chicago only once! I had already been accepted to another school in the Midwest. But when I got the email accepting me to the program, I rearranged everything to come to Columbia Nursing because of, among other things, the strength of its DNP program. I also liked the idea that higher education for nurses is embraced by the New York nurse clinician community.” What challenges do you see for your career path? “One challenge is that there is no national license for nurse practitioners, to level the playing field for what they can and cannot do. There are still states where I can’t prescribe meds. In New York, as a nurse practitioner, I must have a collaborating agreement with a physician who reviews my work, whereas in other states I can be entirely independent in my practice.”

Gyura at the Herman Farrell Jr. Community Health Center at NewYork-Presbyterian Hospital where he provides care to Washington Heights residents

What’s your long-term plan after you earn the DNP? “I will probably return to the midwest to live near family. However, the state I settle in will be partly determined by laws governing our practice. Regardless of where I end up, the DNP will prepare me to serve a population of patients that is often ignored. If we can correct the habits people acquire in their teens and 20s, we can affect their health in their 50s. This is the legacy the DNP will help me create.”

A Brief History of the Doctor of Nursing Practice Degree In a sense, the origin of the DNP degree goes back to the beginnings of nursing itself since it’s a logical extension of nursing education’s focus on safe, effective patient-centered care. Its modern day roots, however, can be traced to a series of three milestone reports issued by the Institute of Medicine, culminating in 2003 with an examination of the education received by health care professionals. That report, “Health Professions Education: A Bridge to Quality,” recommended that to refocus the nation’s health care system on safe, effective patient-centered care, nurses increase their knowledge and skill to deliver enhanced clinical care across services and sites. With this as a backdrop, the leadership of the American Academy of Colleges of Nurses (AACN) convened a task force to explore a clinical practice doctorate in nursing. In 2004, the AACN called for an educational framework that would provide nurses with a doctorate-level of clinical care preparedness. In 2006, the AACN

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member institutions endorsed the Essentials of Doctoral Education for Advanced Nursing Practice, which defined the curricular elements and competencies required in a practice doctorate in nursing. While momentum was building on a national level, Columbia University School of Nursing was ahead of the curve, under the leadership of Dean Mary Mundinger, DrPH, FAAN, who had been working to develop a clinical doctorate. In June 2004, the Columbia University Trustees approved the new degree, DrNP, which raised nursing education to an unprecedented level by preparing advanced practice nurses with the knowledge, skills and attributes necessary for a fully accountable, independent comprehensive practice. Today, the DNP degree awarded by Columbia Nursing stands alone in providing graduates with the ability to deliver complex care, across practice sites and over the lifespan of the patient.

‘‘M

y exposure to health care was fairly traditional. In high school, I volunteered as a candy striper. I knew I wanted to work in the medical field, but as what? A nurse? Physical Therapist? Physician? In the end, I chose nursing because I saw it as the epitome of science and caring. It was a career I could grow with. “I had seen a lot of nurse anesthetists in action in college and afterwards as an RN. I remember a night early in my career when I was in charge, and we called a code on a patient. A nurse anesthetist showed up and he took care of things immediately. To me, he represented that place where nursing meets science meets autonomy. “From that point on, I was sold on pursuing anesthesia, so I did the master’s program at Columbia Nursing. But I realized that I really wanted to be a master clinician, to go as far as I could. So when I learned about the Columbia

Nursing DNP, I started pursuing the idea of a clinical doctorate—evidence-based, collaborative, working with nurse scientists. The DNP makes me a more comprehensive provider. “Day to day, I live in two worlds. In the operating room, we are all members of a team—otherwise, the patient would be put at risk. But then there’s the hospital environment, where nurses have always struggled to make themselves heard. Historically, this has been a constant challenge—and that’s where the DNP has not only broadened my knowledge but enabled me to deliver. “My DNP gives me a voice at the table. It makes me a stakeholder in the hospital environment; it gives me influence in work groups, committees, hospital meetings. With this degree, I can provide a nursing perspective that has credence and allows me to level the playing field somewhat with our physician counterparts. “The DNP also allows nurses to have influence on a broader scale. For example, I was recently appointed to the National Quality Forum, which sets health care standards. This happened partly because I have the DNP. In fact, I would not even have my current job if I did not have the DNP. “That said, nobody faces more turf battles than nurse practitioners and anesthetists. In New York State, nurse anesthetists are recognized only under our RN licenses, so our practice is complicated by current laws. There are only 17 states where anesthetists operate on their own—we still have a long way to go. “All nurses need to decide on a personal direction. What do they really want? Mastery of their field? Policy involvement? Influence on hospital decisions? To create new research and science? If they have a position that requires them to collaborate with nurse scientist colleagues, the DNP is not only useful but often necessary. Certainly, the DNP helped me determine new ways to do things with my colleagues, and I would not be where I am today without it.”

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Walter Bockting, Explores Transgender Health on Its Own Terms By Andrea Kott

Walter Bockting, PhD, is one of the world’s leading experts on transgender health

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In the early 1990s, near the beginning of his career as a clinical psychologist specializing in LGBT health and sexual identity development, Walter Bockting, PhD, spotted a trend that would ignite the research that has made him one of the world’s leading experts on transgender health. It was ten years into the AIDS epidemic. Although the disease had initially affected men who had sex with men, Bockting was seeing increasing incidences among the transgender people in his clinical practice at the University of Minnesota. What he wasn’t seeing, however, was any recognition of this trend. The Minnesota health department was tracking transgender people with HIV, but the Centers for Disease Control and Prevention (CDC) was not; it was simply lumping them in with men who had sex with men, or with heterosexual women. And CDC surveillance data was driving prevention efforts. Bockting, who had worked with transgender individuals extensively as coordinator of the university’s transgender health services, sought HIV–prevention protocols tailored to their experiences and needs, but none existed. In fact, there was little public health research about transgender people at all. Bockting dedicated the next 20 years to conducting this research, which he continues as professor of medical psychology at the Columbia University School of Nursing and the College of Physicians and Surgeons. He is also co–director of the LGBT Health Initiative, a collaboration involving the School of Nursing, the Division of Gender, Sexuality and Health at the New York State Psychiatric Institute, and the Columbia University Department of Psychiatry. The Initiative focuses on research, clinical care, education and policy regarding the health of LGBT people. “By 1995, it was clear that to understand HIV in the transgender community, we had to look at transgender health more broadly,” he said. What began as his inquiry into HIV–prevention needs and corresponding interventions for the transgender community has evolved into a vast body of scholarship. Bockting is internationally known for his expertise in the assessment and treatment of gender dysphoria—the incongruence a person may feel between their sex assigned at birth and their gender identity—and in the general mental health and

psychosocial adjustment of transsexual, transgender, and gender-nonconforming individuals and their families. He received his doctoral degree in psychology from the Vrije Universiteit, Amsterdam, the Netherlands, and was a postdoctoral fellow, and went on to become a tenured professor at the University of Minnesota Medical School’s Program in Human Sexuality, in the Department of Family Medicine and Community Health. In 2010–2011, he served on the Institute of Medicine (IOM) Committee of the National Academies, whose work culminated in the IOM report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. In his many scientific articles, textbook chapters, and books, Bockting has identified a constellation of issues—stigmatization, in particular—that once obscured transgender health, as well as the needs of gender-nonconforming women and men. “Stigma is the overriding theme affecting the health of transgender people,” he said. He learned early in his research that HIV was not among transgender people’s main health concerns. Rather, he said, “Transgender persons’ main concerns are affirming their gender identity and attaining the health care necessary to make the changes needed to transition to living comfortably in a gender role that is congruent with their gender birth.” According to Bockting, transition is first and foremost a psychosocial process. Thus, helping transgender individuals make the physical and social changes needed to affirm their identity is elemental to improving their health and wellbeing, and ultimately, to also prevent HIV infection and transmission, he said. Achieving these goals requires confronting and dismantling social stigma: the negative feelings in society toward transgender individuals and once internalized, the negative feelings transgender individuals feel toward themselves. This stigma and its accompanying stress are the main ingredients in vulnerability to illness—mental and physical—including HIV. “The stress associated with stigma, prejudice, and discrimination will increase rates of psychological distress in the transgender population,” Bockting wrote in a study that appeared last year in the American Journal of Public Health. The Academic Nurse

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In that study, an online survey of 1,093 male-tofemale and female-to-male transgender people, 44.1 percent ranked high on depression, 33.2 percent on anxiety, and 27.5 percent on somatization (physical symptoms that have a psychological cause). Family support, peer support, and identity pride were identified as protective factors that were “negatively associated with psychological distress.” In particular, support from other transgender people was shown to buffer the negative impact of stigma on mental health. Of course, stigma is not unique to transgender individuals. All minorities—especially sexual and gender minorities—experience stigma. Indeed, among the LGBT Initiative’s many goals is to eliminate all forms of sexuality and gender-based stigma and discrimination by conducting research, providing clinical care, and enhancing health care providers’ knowledge of, and sensitivity toward, the diverse needs of sexual and gender minorities, said the director, Anke A. Ehrhardt, PhD. “Progress in knowing about and giving care to these populations has been haphazard over the past 20 to 30 years,” said Ehrhardt, who is vice chair for faculty affairs and a professor of medical psychology in the Department of Psychiatry. “Our focus is not just on HIV but on improving the overall health care for transgender people, which has been largely missing from medical schools.” Although the transgender community is currently allied with the larger LGBT community in the fight for human rights, historically it has been its most marginalized member, Bockting said. This marginalization explains, in part at least, why transgender people fell through the cracks during the early years of the AIDS epidemic. It also explains why so little is known about transgender health. “Transgender people were late in the game when it came to HIV,” Bockting said. “Moreover, there’s a lot we don’t know about the health and wellbeing of the LGBT population more generally because so much of the focus has been on HIV for many years.” The diversity of the transgender population makes the field of transgender health especially rich and complex, Bockting said. Transgender people experience a gender identity that differs from the one assigned at birth. How they express their identity physically in terms of medical or surgical adjustments,

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“By 1995, it was clear that to understand HIV in the transgender community, we had to look at transgender health more broadly.”

or socially in terms of appearance, personality, behaviors, or relationships varies widely. “There is a broad spectrum of gender and sexual diversity,” he said. For example, some people may be assigned male at birth, discover their identity is more female, and begin to live as women. They may take hormones, with or without undergoing surgery. Others may be assigned female at birth, discover a male gender identity, and live as men. Transgender individuals may be attracted to men, women, or both; they may be attracted to other transgender people. Many identify as straight. “Gender identity goes deeper than being a boy or a girl, a man or a woman,” Bockting said. “Some transgender people can’t be described as being male or female. They would describe themselves as being a little bit of both or belonging to a third gender altogether.” What is known about the health of transgender individuals is its association with pervasive social stigma, which commonly traps transgender people in what Bockting calls a “cycle of marginalization.” This cycle may begin with social or professional discrimination and spark an accumulation of unemployment, poverty, homelessness, violence, and depression or substance abuse, which undermine health. “Think of a young transgender man who has just come out to his family,” Bockting said. “His family is struggling to accept his being transgender. At the same time, he’s being bullied in school. All of this makes him vulnerable to dropping out of school, leaving home, and being at risk for homelessness.” The young man may turn to alcohol or drugs. To affirm his identity as a gay trans man, he may have unprotected sex with multiple partners or engage in other high-risk behaviors. “When you have a difficult relationship with your family, or you don’t know how to address your identity on a job application or during a job interview, you can find yourself without much support,” Bockting said. “And if you are homeless, you may have to do

things you ordinarily wouldn’t to afford a place to stay.” Compared with lesbians, gay men, and bisexual and heterosexual men and women, transgender people have higher rates of depression, anxiety, and suicidal ideation, Bockting has found. Among the transgender women and men he surveyed, 71 percent had experienced verbal harassment, 38 percent had had difficulty finding a job, 23 percent had lost a job, 25 percent had problems obtaining health services, 24 percent had experienced physical abuse, and 12 percent had been denied housing. “It is One of the efforts of the LGBT Health Initiative, where Bockting serves as co-director, is to identify the best practices to fight stigma and promote the mental health of LGBT people the social determinants of health that make them most vulnerable,” he said. Across 29 studies focusing on transgender As pernicious as external stigma is the internal people’s vulnerability to HIV, risk behaviors included stigma that plagues many transgender people. unprotected receptive anal sex (44 percent), sex Bockting describes this as felt stigma, the perception while drunk or high (39 percent), and needle sharing or anticipation of rejection and the fear of not “passing” during hormone or silicone use (6 percent). Mental as a member of the other sex. Coping with this fear health issues (54 percent suicidal ideation, 31 percent causes some individuals to conceal their gender suicide attempts), illicit hormone use (34 percent), and identity, which actually reinforces felt stigma and stress, homelessness (13 percent) increased their vulnerability he said. “Concealment is an attempt to avoid the to HIV. Other studies have found that transgender negative consequences of stigma, but it can result in a women of color who had dropped out of school, were preoccupation with hiding, which itself can become a unemployed, or had been sexually assaulted were significant source of stress,” he wrote in the American also more likely to be HIV positive. In additional but Journal of Public Health. unrelated research, HIV–positive transgender women Felt stigma also may prevent transgender people were less likely than other groups to be engaged in from seeking health care, Bockting said. The fear of HIV care. being identified—or simply regarded—as HIV positive According to Bockting, transgender women may prevent some from visiting a clinic for testing experience more job discrimination than nonor treatment, he said. The fear of losing a potential transgender women and are therefore more likely romantic partner may discourage some from disclosing to turn to prostitution. As a result, they may engage their positive HIV status. “Many transgender people in substance use, impairing their ability to make sound are looking for love, to be accepted and valued for judgments, let alone negotiate condom use. In addition, who they are,” Bockting said. “Sometimes people are feminizing hormones can cause mood swings or not willing to risk potential rejection after they’ve found sexual functioning difficulties when improperly used, someone who can deal with their being transgender.” impeding judgment. “Mood swings can make you more The anticipation of rejection, discrimination, or vulnerable to high-risk behaviors,” Bockting said. harassment extends to health care settings, as well.

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More than a quarter of transgender adults have experienced discrimination by a physician or been denied health insurance because of their gender identity. In one study, 40 percent of older transgender adults feared accessing health services outside the LGBT community. Reducing stigma, therefore, especially in health care settings, is paramount to improving transgender health and is an important focus of the LGBT Health Initiative that Bockting co-directs This requires clinical as well as cultural competence. Clinical competence includes helping people work through feelings of gender dysphoria, (discomfort with sex characteristics and/or gender role), supporting them as they make a social and/or medical transition, and helping them to access hormone therapy or surgery, and adjust to living life as a transgender person. It also entails recognizing, as Bockting said, that “hormone therapy and surgery are just two interventions within a much broader process of coming out,” underscoring the importance of facilitating family and peer support. Cultural competence, he said, “is about how we interact with patients. Affirming transgender people’s gender identity and validating and supporting their social transitions are essential. Providers should call transgender patients by their preferred name or the appropriate corresponding pronoun, rather than by the name given to them at birth, Bockting said. “People’s identities must be accommodated in their electronic health record.” When providers ask about gender,

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they should pose two questions: What is your current gender identity? (male female, transman, transwoman, genderqueer, other), and what sex were you assigned at birth (male or female)? “Both questions are important,” Bockting said. Asking transgender patients who they are attracted to should also be included in a regular assessment, he added. Moreover, providers should be fully informed of a patient’s history of hormone therapy and its health implications. These are among the key lessons included in the course materials that Bockting has developed as part of his work with the LGBT Health Initiative. While asking patients about their gender identity or sexuality, providers need to keep in mind that this information will help them improve the care they give, said Ragnhildur Ingibjargardottir Bjarnadottir, BSN, MPH, a PhD student at Columbia Nursing who is working with Bockting on a study about the barriers and opportunities nurses encounter in assessing LGBT and transgender patients within the Visiting Nurse Service of New York. “In the context of a home health assessment, we may not be able to get the whole picture of what this population looks like, but we can try to identify the challenges that many share, so we can improve our services,” Bjarnadottir said. Said Bockting, “When people have better access to health care and are better accommodated in terms of their gender and sexual orientation, when their identity is affirmed, they’re going to have better self-esteem and take better care of themselves.” And when people take better care of themselves, they are in a better position to benefit from early interventions to prevent a cycle of cumulative disadvantage and marginalization. At the same time, providers must be aware of the sex assigned to a person at birth. First, Bockting said, “transgender women keep their prostate even after genital surgery, so if it’s a primary care clinic, providers must not forget to do a prostate exam.” Second, “most transgender men still have a uterus and ovaries and may need gynecological care.” Third, people’s genetic blueprint informs the trajectory of their health. Even though a transgender woman may identify as female, her body and brain are still chromosomally male. “She is not like most other woman; she is a transgender woman. A transgender woman has a

history of being male,” Bockting said, and in addition she has a unique experience that differs from the experience of nontransgender women and men. It’s about improving our understanding of transgender people’s unique experience and integrating the idea that there are more than two genders into practice.” Of course, there is a conundrum: How do providers assess the health status and make prognoses without knowing what is typical for a transgender person? Do they compare transgender patients with male or female norms? “We need to advance our knowledge in this area,” Bockting said. “We may need to compare transgender women with other transgender women, and transgender men with other transgender men. “We need to learn more about what is normative for them and take this into account so we can serve them better.” Likewise, the creation of public policy in this and many other issues, needs to be addressed by expanding the evidence base, a significant goal of the LGBT Health Initiative. Bockting said more research is needed on the health of transgender people and on the psychosocial factors that make them vulnerable to certain risk behaviors, health behaviors, and health concerns, including but not limited to HIV. The LGBT Health Initiative is about to launch such research: a longitudinal study of transgender women and men age 16 and

Anke Ehrhardt, PhD, director of the LGBT Health Initiative (left), with Walter Bockting, PhD, (right)

older who are at various stages of coming out and transitioning and who are at risk for HIV and other health concerns. The study will aim to provide a better understanding of identity development among transgender people, while examining their vulnerability and to resilience across their lifespan. Bockting said, “When you look at vulnerability in a developmental context, you can actually understand how the health inequities and challenges people face come about. They just all don’t happen at the same time. They are related to what people are going through as they seek to affirm their gender identity and live their lives as women, men, and persons of transgender experience.” Ultimately, Bockting and his co-investigators hope to determine what resources and policies are associated with transgender people’s resilience, so as to

develop interventions to help them overcome the challenges they face during coming out and throughout their lives. “The goal is to place these challenges on a developmental timeline and identify where we can intervene early and what kind of strengths help people make it through challenging times,” he said. The study will provide important insights into transgender people’s experiences and needs, their ability to cope with stigma, and ways that providers can serve them better. “To make progress with HIV in the transgender population, we need to understand other health issues that often are of higher priority for transgender people themselves,” Bockting said. “It will not only be another step toward ending the AIDS epidemic; it will be good for promoting transgender people’s overall health.”

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To Stop Hospital Infections, Start at the Top By J. Duncan Moore, Jr.

Patricia Stone, PhD, RN, FAAN, could get an idea of a hospital’s infection rate just by seeing who took the time to meet with her at the dozens of hospitals she visited as part of her research on the effectiveness of U.S. infection control. While she spoke with prevention specialists, physicians, and bedside nurses—“most everybody involved” in a hospital’s effort to reduce infection rates—it was the hospital executives who provided the first, and often most telling, sign. “Although our interview with this one hospital president was scheduled for later in the day, he made a point of greeting us when

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we arrived,” she recalls of one site visit. “And when we left, he again made time in his day to see us off. At another hospital, the top administrator wasn’t available and the physician we were interviewing—the ICU hospitalist—arrived late and sorted through his emails as we spoke. Ten minutes later, he was gone.” “We knew their infection rates in advance,” she concludes slyly. “Which one do you think had the lower rate?” If U.S. hospitals are truly to move the needle on infection control, top leadership has to recognize the problem, show commitment and perseverance, and devote all the resources necessary to implement and enforce evidence-based prevention strategies, Stone says. And all of the clinicians on the front lines have to work together as a team that puts patient safety first. The impetus for sustained, effective infection control “has to come from the top,” says Stone, who is the director of the Center for Health Policy at Columbia Nursing and Centennial Professor of Health Policy. Stone recently published the most comprehensive survey of U.S. hospital infection control efforts in more than three decades. The study, “State of Infection Prevention in US Hospitals enrolled in the National

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Health and Safety Network,” recently appeared in the American Journal of Infection Control. Co-authors from Columbia Nursing were Monika Pogorzelska-Maziarz, PhD, MPH, associate research scientist; Carolyn T.A. Herzig, MS, PhD candidate; and Elaine Larson, PhD, RN, FAAN, associate dean for research. The other co-authors were E. Yoko Furuya, assistant director of hospital epidemiology for Columbia University Medical Center; Andrew Dick, an economist at RAND Corporation; and Lindsey M. Weiner, a statistician with the Centers for Disease Control and Prevention. The report provides a national snapshot of infection prevention and control programs in intensive care units (ICUs), as well as a review of how well clinicians are complying with the implementation of evidence-based processes to prevent health care-associated infections (HAIs). The project, known as the Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) study, was funded by the National Institute of Nursing Research, the National Institutes of Health, and supported by the Centers for Disease Control (CDC). Stone’s team reviewed compliance policies at 1,653 ICUs at 975 hospitals nationwide. It focused on three of the most common preventable infections: central-line associated bloodstream infection (CLABSI), catheterassociated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP).

The study found that, despite decades of research establishing best practices for prevention of these infections, approximately one in 10 hospitals lack checklists to prevent CLABSI, and one in four lack checklists to prevent VAP. Even worse, the checklists are followed only about half of the time, the study found. “Establishing infection-control policies in the hospital is insufficient,” Stone says. “There needs to be a focus on the clinicians at the bedside, to make sure they are doing the right thing every time.” Most hospitals take what’s known as a bundle approach to infection control, a strategy that deploys checklists of evidence-based practices to follow at the bedside along with protocols for monitoring compliance. Catheters, for example, can transmit deadly infections to the bloodstream or urinary tract if clinicians don’t follow proper insertion, utilization, and maintenance policies. ICU patients can be protected against CLABSI through simple infection-prevention measures such as hand washing before handling the catheter and immediately changing the dressing around the central line if it gets wet or dirty. Guidelines to prevent CAUTI are more recent, and there are no universally accepted checklists to follow at the bedside. About one third of hospitals had no prevention polices in place to prevent these infections. Even at hospitals that had established guidelines, they were followed less than 30 percent of the time, the study found. To avoid VAP, precautions on bedside checklists typically include raising the head of the bed 30 to 45 degrees, providing a daily sedation vacation to assess the patient’s readiness for unassisted breathing, and providing medication to prevent stomach ulcers and mouth sores. Even though most hospitals have adopted at least some checklists, “it’s very difficult for everyone to do the right thing the right way every single time,” said co-author Furuya, an epidemiologist at NewYorkPresbyterian Hospital. “Patients in the ICU are very sick and very complex. There are so many competing priorities. You’re trying to prevent bloodstream infection; you’re trying to prevent them from falling out of bed or getting a pressure ulcer; and you’re trying to prevent a catheter urinary tract infection—all at the same time.” Nurse staffing levels can pose another hurdle to infection control. If one nurse is assigned to care for several ICU patients at once, “then it becomes almost impossible to pay attention to everything,” says Furuya. Given the complexity of ICU care, in many cases hospitals try to assign just one patient to each nurse. This has become a more common ICU staffing goal, as patients arrive at the hospital older, sicker, and often with multifaceted medical issues involving the control of infection, such as organ transplantation.

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Winning the Battle Reducing HAIs has been elevated to one of the CDC’s 10 “winnable battles,” along with improving food safety, preventing teen pregnancy, and eradicating HIV. These are “public health priorities with large-scale impact on health, and with known, effective strategies to address them,” the CDC says on its website. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. HAIs kill an estimated 100,000 Americans a year and create approximately $33 billion in excess medical costs, according to the CDC. For NewYork-Presbyterian Hospital, preventing HAIs involves everyone who comes in contact with a patient, including nurses, physicians, and visitors, says Wilhelmina Manzano, MA, RN, senior vice president and chief nursing officer at NewYork-Presbyterian and assistant dean for clinical affairs at Columbia Nursing. “It begins with the question, `do we have the right training for all the individuals?” Manzano says. “And not just for our health care professionals, but anybody who interacts with patients. It’s a massive undertaking to make sure everybody who needs to have the right information has it.” Patient education and empowerment are also essential, she says. “If I am a patient in the hospital bed, I should be comfortable asking, ‘Did you wash your hands?’ The most basic thing we can do to prevent infection is hand washing. With everything we do to provide the best care possible at the bedside, it’s imperative that we remember to do the simple things, like washing hands.” To ensure that every clinician on the health care team remains vigilant, the hospital has various interdisciplinary initiatives led by senior executives, focused on improving communication and patient safety. Additionally, staff are educated during orientation and on annual updates, and everyone is held accountable for their practice and patient outcomes. These interventions have pushed hospital-wide adherence to hand washing to 98 percent, Manzano says. The hospital’s standardized infection ratio for CLABSI in the ICU is 0.58—“the lowest we’ve ever seen, and we exceeded our goal.” Daily bathing of patients with antibacterial soap and a focus on proper maintenance of central lines proved effective in pushing those infection rates down, she says. For many years, hospitals had little incentive to reduce their infection rates. If a patient got an HAI, the hospital could bill Medicare or the private insurer for the costs of the new diagnosis and extended stay. That changed in 2005, when Congress instructed the Centers for Medicare and Medicaid Services (CMS) to stop paying additional costs associated with a condition that the patient acquired during the initial hospitalization. The policy was implemented in 2009 and taken up by many private insurers. Then in 2010, as part of the Affordable Care Act, Congress enacted the more stringent Hospital Acquired Conditions (HAC) program, with mandatory reporting of infection rates; it goes into effect in 2015. Hospitals 28

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will be ranked in quartiles, and those with the highest infection rates will have one percent deducted from their total Medicare payments—a huge hammer, as Medicare is the largest source of revenue for most hospitals. Medicare payments aren’t the only funds jeopardized by high infection rates. CMS lets consumers see infection rates online on its HospitalCompare website, a tool that empowers patients to steer clear of hospitals with terrible scores for HAIs. When it’s not an emergency, prospective patients can look online before choosing a hospital, to see how the facility stacks up against national and state benchmarks in CLABSI, CAUTI, surgical-site infections, methicillin-resistant staphylococcus aureus (MRSA) blood infections, and clostridium difficile (C. diff.) infections.

Accountability as an Intervention Tracking infection and making HAI rates public are key levers being used by government agencies to get the upper hand in infection control, says Carolyn V. Gould, MD, who leads the acute care team in the Prevention and Response Branch, Division of Healthcare Quality Promotion, at the CDC. “We are looking at hospitalspecific data and saying, `Where does there need to be more improvement?’ and then focusing efforts on those hospitals that seem to be having some problems,” Gould says.

The most comprehensive review of infection control efforts at U.S. hospitals in three decades led by Patricia Stone, PhD, RN, FAAN (above) found most hospitals don’t follow policies proven to prevent life-threatening infections

Collecting and sharing data is critical to the enterprise of infection prevention. Medical literature demonstrates time and again that it’s not sufficient to lecture people on doing the right thing. You have to show them their data. “When you tell surgeons what their surgical infection rate is, they get better,” Furuya said. “It’s a powerful motivator for change.” This public display of a hospital’s HAI rates also works as an effective incentive to safeguard a hospital’s reputation. This, combined with the impending financial penalty from CMS for a poor showing, forces executives to become more aware of all that is at stake, Stone says, improving the likelihood that “they can really lead and give people the resources they need.” The importance of HAIs needs to be visible all the way to the board level, she adds. The hospital board level is where the corrective action really needs to take root, said James L. Reinertsen, MD, a consultant and former senior fellow at the Institute for Healthcare Improvement. Board members are waking up to the fact that their role has migrated from being responsible for finances and facilities to being leaders of a clinical-care system. “They are responsible for everything in the organization—especially what goes wrong clinically,” he said in an interview in the Joint Commission Journal on Quality and Patient Safety. Stone’s study is the most significant follow-up to the CDC’s seminal Study on the Effectiveness of Nosocomial Infection Control (SENIC), undertaken in the 1970s, which established that hospitals with wellorganized infection control programs had lower HAI rates. That, and subsequent research, set basic expectations and requirements for effective infection-control measures in hospitals. The goal of the present study was to assess the current state of affairs. One of the study’s most surprising findings is that hospitals are employing a higher ratio of infection-prevention specialists per patient bed than those in the recommendations established just a decade ago. “It’s risen to the top,” says Stone. We need to continue to invest in that.” Infection- control departments can range from one person at a small hospital to a large group at a major medical center. At

NewYork-Presbyterian Hospital, there are seven physicians, including Furuya, plus 13 infection preventionists, most of whom are nurses, as well as a group of managers and data analysts. “We do everything we can to make sure patients and health care workers and anyone else in the hospital minimize their risk of developing an infection,” Furuya says. While those focused on infection certainly help lower HAIs, these individuals often spend too much of their time on surveillance and documentation for quality reporting, instead of working with front-line staff at the patient bedside, where they could add more value. Furuya thinks part of the solution is more resources for data management. “If you have somebody whose job it is to collect data or put reports together, that is time the infection preventionist can spend out on the floor.” It also helps if hospitals invest in information systems for infection control. Such systems offer “a way of extracting data, getting rid of the statistical noise, separating out what you need to look at,” thus saving manual labor. The most important thing to keep in mind, Stone says, is that infection prevention obligates everyone in the hospital to work as an interdisciplinary team. “They have to work together, have the right policies in place, and ensure that everybody is adhering to them. It’s a culture of collaboration that we need.”

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School News 31 34

Selected Faculty Publications 2013 - 2014

Selected Faculty Honors and Presentations 2013 - 2014

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Alumni Association

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Letter from the President

Selected Faculty Publications 2013 - 2014 Mary Byrne, PhD, Stone Foundation and Elise D. Fish professor of Health Care for the Underserved in Nursing, was an author of “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” published in American Journal of Nursing (in press), “In Their Own Voices: The Experience of Professional Nurses at a Northern Vietnamese Hospital”, published in Contemporary Nurse (in press), “Preschool Outcomes of Children Who Lived as Infants in a Prison Nursery,” published in The Prison Journal (in press), “Recidivism after Release from a Prison Nursery Program,” published in Public Health Nursing. Eileen Carter, PhD candidate, was lead author of “The Relationship between Emergency Department Crowding and Patient Outcomes: A Systematic Review,” published in The Journal of Nursing Scholarship. Karen Desjardins, DNP, MPH, assistant dean of academic affairs, was the lead author of “Empowering Women: Teaching Ethiopian Girls to Make Reusable Sanitary Pads,” in Clinical Scholars Review. Mary Moran, FNP, MPH, RN, clinical instructor, was also an author. Jennifer Dohrn, DNP, CNM, director, Office of Global Initiatives, authored “Building Nurse and Midwifery Capacity in Malawi: A Partnership between the Government

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of Malawi and the PEPFAR/Nursing Education Partnership Initiative (NEPI),” a chapter in Transforming the Global Health Workforce. Dawn Dowding, PHD, RN, VNSNY Professor of Nursing, authored “Using Computerized Decision-Support Systems,” published in Nursing Times, “An Agenda for Clinical Decision Making and Judgment in Nursing Research and Education” published in the International Journal of Nursing Studies and “Are Nurses Expected to Have Information Technology Skills?” published in Nursing Management. She was also an author of “A Systematic Review on the Validity and Reliability of the Manchester Triage System,” published in the International Journal of Nursing Studies. Laurie Conway, MPhil, CIC, PhD candidate, was the lead author of “Tensions Inherent in the Evolving Role of the Infection Preventionist,” published in the American Journal of Infection Control (AJIC). Other authors on the article included Monika Pogorzelska-Maziarz PhD, MPH, associate research scientist; May Uchida RN, MPhil, PHD candidate; Patricia Stone, PhD, RN, FAAN, Centennial Professor in Health Policy; and Elaine Larson, PhD, RN, FAAN, CIC, associate dean for research. William Enlow, DNP, ANCP, CRNA, assistant professor, was the lead author of “Strategic Planning for Curricular Excellence, Anesthesia and Comprehensive Care,” published in AANA Journal. Other authors of the paper include Judy Honig, DNP, EdD,

CPNP, associate dean for student affairs, and Sarah Sheets Cook, DNP, RN, professor emerita. Judy Honig, DNP, EdD, CPNP, associate dean for student affairs, was the lead author of “Building Framework for Nursing Scholarship: Guidelines for Appointment and Promotion,” published in The Journal of Professional Nursing. Haomiao Jia, PhD, associate professor of biostatistics was an author of “L. Surgical Site Infections and Bloodstream Infections in Infants after Cardiac Surgery,” published in the Journal of Thoracic and Cardiovascular Surgery and “Translating Using RE-AIM of a Falls Behavior Change Program Among an Assisted Living Population,” published in Family & Community Health. Rita Marie John, DNP, EdD, director, Pediatric Primary Care Nurse Practitioner Program co-authored “Everything the Nurse Practitioner Should Know about Pediatric Feeding Tubes,” published in the Journal of the American Academy of Nurse Practitioners. Mary Johnson, DNP, ACNP-BC, program director, Adult Gerontology Acute Care Nurse Practitioner Program, was the lead author of “Transitions of Care in Patients Receiving Oral Anticoagulants: General Principles, Procedures, and Impact of New Oral Anticoagulants, published in the Journal of Cardiovascular Nursing, “Manikin vs Web-based Simulation for Advanced Practice Nursing Students,” published in Clinical Simulation

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in Nursing. In addition, she was an author of “The Use of Non-Physician Providers in Adult Intensive Care Units, published in The American Journal of Respiratory and Critical Care Medicine, and a chapter “Nurse Practitioners in Trauma Care,” in The Encyclopedia of Trauma Care. Joan Kearney, PhD, CS, APRN, assistant professor, was a lead author of “Understanding Parental Behavior in Pediatric Palliative Care: Attachment Theory as a Paradigm,” in Palliative and Supportive Care. Mary Byrne, PhD, Stone Foundation and Elise D. Fish professor of Health Care for the Underserved in Nursing, was an author. Kristine Kulage, MA, MPH, director, Office of Scholarship and Research Development, was the lead author of “How Will DSM-5 Affect Autism Diagnosis? A Systematic Literature Review and Meta-analysis,” published in the Journal of Autism and Developmental Disorders. Co-authors of the paper include Arlene Smaldone, PhD, RN, associate professor and Elizabeth Cohn, PhD, RN, assistant professor. Jeffrey Kwong, DNP, MPH, ANP-BC, program director, AdultGerontology Nurse Practitioner Program, was the lead author of “Leadership Skillset for the Advanced Practice Registered Nurse,” in DNP Education, Practice & Policy: Redesigning Practice Roles for the 21st Century. Elaine Larson, PhD, RN, FAAN, associate dean for research, was an author of “Risk Factors for 32

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Catheter-Associated Urinary Tract Infections in Critically-Ill Patients with Subarachnoid Hemorrhage,” published in the Journal of Neuroscience Nursing (in press). Jingjing Shang, PhD, RN, OCN, assistant professor, was also an author. Lori Lynch, MSN, APRN, PNP-BC instructor, was an author of “Bias and the Obese Adolescent: Revealing Stories from their Caregivers,” published in Bariatric Nursing and Surgical Patient Care. Mary Mundinger, DrPH, dean emeritus and Edward M. Kennedy Professor of Health Policy authored the book “A Path to Nursing Excellence, the Columbia Experience.” Lusine Poghosyan, PhD, RN, assistant professor, was the lead author of “Nurse Practitioners as Primary Care Providers: Creating Favorable Practice Environments in New York State and Massachusetts,” published in Health Care Management Review (in press). Other authors included Jingjing Shang, PhD, RN, OCN, assistant professor and Bobbie Berkowitz, PhD, RN, FAAN. She was also the lead author of “Nurse Practitioner Organizational Climate in Primary Care Settings: Implications for Professional Practice,” published in The Journal of Professsional Nursing (other authors included Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy in Nursing and Arlene Smaldone, PhD, assistant dean, Scholarship and Research); and “Revisiting Scope of Practice Facilitators and Barriers for Primary Care Nurse Practitioners,” published in

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Policy, Politics and Nursing Practice. Jacqueline Merrill, PhD, MPH, RN, associate professor, was an author of “The Influence of Management and Environment on Local Health Department Organizational Structure and Adaptation: A Longitudinal Network Analysis,” published in Journal of Public Health Management and Practice and “Implementing Health Information Exchange for Public Health Reporting: A Comparison of Decision and Risk Management of Three Regional Health Information Organizations in New York State,” published in Journal of the American Medical Informatics Association. Nancy Reame, PhD, RN, FAAN, Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion in the Faculty of Nursing was an author of “Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms,” published in the Journal of Behavioral Health Services & Research. Rebecca Schnall, PhD, assistant professor, was the lead author of “Feasibility Testing of a Web-based Symptom Self-Management System for Persons Living With HIV,” published in the Journal of the Association of Nurses in AIDS Care. Other authors on this paper include Haomiao Jia, PhD, associate professor of biostatistics. Jingjing Shang, PhD, RN, OCN, assistant professor, was the lead author of “The Prevalence of Infections and Patient Risk Factors in Home Health Care: A Systematic Review,”

published in American Journal of Infection Control (in press). Other authors include Lusine Poghosyan, PhD, RN, assistant professor; Dawn Dowding, PhD, professor, and Patricia Stone, PhD, RN, Centennial Professor of Health Policy. In addition, she was the lead author of “Nurse Employment Contracts in Chinese Hospitals: Impact of Inequitable Benefit Structures on Nurse and Patient Satisfaction,” published in Human Resources for Health. She was also an author of “Fever: Addressing Knowledge in Pediatric Caregivers,” published in Advance for NPs and PAs (in press), and “Impact of a Home-based Walking Intervention on Outcomes of Sleep Quality, Emotional Distress, and Fatigue in Patients Undergoing Treatment for Solid Tumors,” published in Oncologist. Pat Stone, PhD, RN, FAAN, Centennial Professor in Health Policy, was the lead author of “State of Infection Prevention in US hospitals Enrolled in the National Health and Safety Network,” published in The American Journal of Infection Control. Other authors included Monika Pogorzelska-Mazairz, PhD, MPH, associate research scientist; Carolyn Herzig, MS, project director; and Elaine Larson, PhD, RN, FAAN, associate dean for research. She was also an author of “Night and Day in the VA: Associations Between Night Shift Staffing, Nurse Workforce Characteristics, and Length of Stay,” published in Research in Nursing & Health; “State Focus on Health CareAssociated Infection Prevention

in Nursing Homes, published in American Journal of Infection Control (in press); and “Translating Infection Control Guidelines Into Practice: Implementation Process Within a Health Care Institution,” published in Qualitative Health Research. Arlene Smaldone, PhD, assistant dean, Scholarship and Research was an author of “The Use of Vitamin K Supplementation to Achieve INR Stability: A Systematic Review and Meta-Analysis,” published in The Journal of the American Academy of Nurse Practitioners and Using Information Techonology and Social Networking Strategies for Difficult to Recruit Pediatric Research Populations,” published in the Journal of Medical Internet Research. Nancy Reame, PhD, RN, FAAN, Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion in the Faculty of Nursing was also an author. Caroline Sullivan, DNP, assistant professor, and Janice Smolowitz, DNP, EdD, senior associate dean, authored “Patient Notification of Test Results in a Primary Care Setting,” published in Clinical Scholars Review. Mary Tresgallo, DNP, MPH, assistant professor, was an author of “Improving Acute Management of Vaso-occulsive Pain in Pediatric Sickle Cell Disease with Use of a Clinical Pathway”, published in Pediatric Blood & Cancer and “Undetected Ultracet™ Dependence in an Adolescent with Nonmalignant Back Pain,” published in Journal of Opioid Management.

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Selected Faculty Honors and Presentations 2013 - 2014 AMIA- American Medical Informatics Association November 16-20, Washington D.C. Adriana Arcia, PhD, RN, postdoctoral research fellow won the Harriet H. Werley Award exploring methods for designing and evaluating the effectiveness of visual tools to convey medical information. It was completed as part of the Washington Heights-Inwood Informatics Infrastructure for Comparative Effectiveness Research (WICER), a multidisciplinary project that aims to understand and improve the health of a largely Hispanic community in New York City. Suzanne Bakken, PhD, RN, FAAN, FACMI, Alumni professor of Nursing and professor of Biomedical Informatics, is the principal investigator for WICER, funded by the Agency for Healthcare Research and Quality. “Method for the Development of Data Visualizations for Community Members With Varying Levels of Health Literacy,” Arcia A., Bales M., Brown W., Co M., Gilmore M., Lee Y., Park C., Prey J., Velez M., Woollen J., Yoon S., Kukafka R., Merrill J., Bakken S. “Patients’ Self-Reported Desire to Participate in Shared Decision Making,” Cato K., Bakken S. 34

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“Analysis of Motivational Concepts in Tweets Related to Jogging,” Yoon S., Shaffer J., Momberg J., Bakken S. “Use of the Health-ITUEM for Evaluating Mobile Health Technology,” Schnall R., Yen P., Rojas M., Brown W. “Impact on Immunization Registry Reporting Following Adoption of an Electronic Health Record,” Merrill J., Keeling J., Phillips A., Kaushal R., Senathirajah Y. “Change in Health Department Organizational Networks After an Evidence-Based Performance Improvement Intervention,” Park C., Byon H., Keeling J., Beitsch L., Merrill J. “Predisposing, Enabling and Reinforcing Factors for Health Information Exchange Opt-In Consent for Persons Living With HIV/AIDS,” Ramos S.R., Bakken, S. “Interest in Using an Electronic Personal Health Record Among a Largely Hispanic Immigrant Population,” Lucero R.J., Shang, J., Liu J., Bakken S.

Laura Ardizzone, DNP ’10 ANES ’04 was appointed as a member of the National Quality Forum’s Patient Safety Steering Committee. Penelope R. Buschman, MS, RN, PMHCNS-BC, FAAN, director, Psychiatric Nurse Practitioner Program, presented “Predictors of Retention for Behavioral Health

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Nurses” at the American Academy of Nursing. In addition, she received the Dorothy H. and Thomas L. O’Neill Distinguished Faculty Award.

Performance,” at the American Association of Nurse Anesthetists Assembly of School Faculty in San Diego, CA.

Mary Byrne, PhD, Stone Foundation and Elise D. Fish professor of Health Care for the Underserved in Nursing was invited as an international expert on co-residence programs for criminal justice involved mothers and their babies at the University of British Columbia, Vancouver. She also presented an administrator/staff workshop at the National Offender Management Services, in London, UK.

Rita Marie John, DNP, EdD, director, Pediatric Primary Care Nurse Practitioner Program, presented the “What’s New in Pediatrics” plenary and “ENT Assessment for School Nurses,” breakout session at the 30th Anniversary North Carolina School Nurse Conference. In addition, she presented “Pediatric Mental Health Specialist Certification Review,” and “Pedialabs for the New PNP,” at The National Association of Pediatric Nurse Practitioners (NAPNAP) annual conference in Boston, MA.

Rozelle Corda, FNP, assistant professor, presented “Evidence Based Management Strategies to Reduce Surgical Site Infections in Neonates Undergoing Cardiac Surgery,” at the Congenital Heart Disease-Clinical Care and Translational Research meeting in Shanghai, China. Karen Desjardins, DNP, MPH, assistant dean of academic affairs, presented “Incivility in Nursing Education,” a Columbia Nursing Anna C. Maxwell teaching seminar and “Interprofessional Education for the Practice-Focused Doctorate” at the American Association of Colleges of Nursing (AACN) Doctoral Education Conference, in Naples, FL. Will Enlow, DNP, ACNP, director, Continuing Nursing Education, assistant director Nurse Anesthesia Program, presented a workshop on careers in nursing to high school and college students at the Borough of Manhattan Community College. He also presented “Evaluating Clinical

Jeffrey Kwong, DNP, MPH, ANP-BC, program director, AdultGerontology Nurse Practitioner Program, presented “HIV & Anal Cancer,” at the New Jersey AIDS Education and Training Center; “HIV Pre-exposure Prophylaxis: An Update for Clinicians,” at Sydenham Health Center, New York, NY; “Managing Adverse Effects in the HIV/HCV Co-Infected Patient,” at the International Conference on Viral Hepatitis, New York, NY; “Working with Young MSM: Strategies for Success,” at the Renaissance Health Care Network, New York, NY; “HIV and Anal Cancer: An Update for Providers,” at St. John’s Riverside HIV Program, New York, NY; “Medical Marijuana: HIV Clinicians’ Knowledge, Attitudes, and Practices,” poster presentation at the 26th Annual Conference of the Association of Nurses in AIDS Care, Atlanta,

GA; “HIV Prevention: What Every Nurse Practitioner Needs to Know,” poster presentation at American Academy of Nurse Practitioner Annual Conference, Las Vegas; “Developing an Interprofessional Model of Care in a Nurse Managed Health Center,” poster presentation at the 31st Interprofessional Technology Conference in Atlantic City, NJ.

presented “Musculoskeletal Pain in Perimenopause: a Qualitative Study,” at the 24th Annual Meeting of the North American Menopause Society.

Kathleen Hickey, EdD, FNP, FAAN, assistant professor, presented on translating genomic-based research for health at the Institute of Medicine (IOM) Roundtable in Washington, D.C. at a meeting entitled “Assessing Genomic Sequencing Information for Health Care Decision Making: A Workshop.”

Rebecca Schnall, PhD, assistant professor, was selected as an Alliance for Nursing Informatics (ANI) Emerging Leader and presented a Webinar, “Adolescents’ Use and Perceived Usefulness of Mobile Technology for Meeting their Health Information Needs and Improving Adherence to Improved Health Behaviors,” for the Office of Behavioral and Social Sciences Research at the National Institutes of Health (NIH).

Judy Honig, DNP, EdD, PNP, associate dean of student affairs, was installed as the Dorothy M. Rogers Chair. Marlene McHugh, DNP, DCC, FNP-BC, ACHPN, presented “ER and Outpatient Management of Patients with Chronic and Advanced Illness in an Underserved Community, NP/MD Model of Care,” at Innovative Models of Transitional Care: Bridging the Gap from Theory to Practice, a joint conference sponsored by Columbia Nursing and Visiting Nurse Service of New York; and “Preparation and Care for the Time of Death,” at NewYorkPresbyterian Hospital for Palliative Care Physician Fellows. Nancy Reame, PhD, RN, FAAN, Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion in the Faculty of Nursing

Jeanne Rubsam Kane, APRN, PNP-C, assistant professor, was elected as Vice President of the New York State American Trauma Society for the 2014-2016 term.

Jan Smolowitz, DNP, EdD, senior associate dean, clinical practice, presented “ABCC Certification: What It Is and What It Isn’t” at the American Association of Nurse Anesthetists Assembly of School Faculty in San Diego, CA. Mary Tresgallo, DNP, MPH, presented “The Ethical Considerations of Left Ventricular Assist Device (LVAD) as Destination Therapy in a Child Diagnosed with Dilated Cardiomyopathy (DCM) and Duchenne’s Muscular Dystrophy (DMD)” at the Society of Pediatric Anesthesiology Meeting in Las Vegas, NV. She also participated as one of 11 faculty members in a Bioethics mediation training sponsored by Morgan Stanley Children’s Hospital.

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Alumni Association 2013-2014 Alumni Association members are all Columbia University and Presbyterian Hospital School of Nursing graduates. The Alumni Association works with the Office of Development and Alumni Relations to develop programs designed to connect alumni with the School and with each other. Within the Alumni Association, alumni participate by class and program. All Alumni Association initiatives are designed to promote the strengthening and renewal of alumni friendships and partnerships that enhance the School, including encouraging support of the Annual Fund.

President Martha Cohn Romney ‘81 President (2012-2015) Vice President, Annual Fund Beth Zedeck ‘04 ‘06 (2011-2014) Nominating Chair Sarah C. James ‘97 (2013-2016) Secretary Maria Magliacano ‘06 (2011-2014) Directors Ellen Soley Adkins ‘81 (2013-2016) Laura Pearson Armstrong ‘85 (2011-2014) Monica Buff Burrell ‘09 ‘12 (2013-2016) Sharron Close ‘01 ‘03 ‘11 (2011-2014) Patricia C. Dykes ‘04 (2012-2015) Ellen Gottesman Garber ‘76 (2012-2015) Michelle Kolb ‘05 ‘09 (2012-2015) Marguerite “Peggy” Lorey Peoples ‘57 (2012-2015) Rosalie Perez ‘04 ‘07 (2011-2014) Julie Schnur ‘03 ‘05 (2010-2013) Karla Silverman ‘98, ‘01 (2012-2015) Catherine Tanksley ‘98 (2011-2014) Glenn Wurtzel ‘00 ‘02 (2011-2014) Dean Bobbie Berkowitz, PhD, RN, FAAN Associate Dean for Development & Alumni Relations Reva Feinstein

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From the President Martha “Marty” Cohn Romney ’81 RN, MS, JD, MPH Alumni Association President It is a pleasure to write this letter on the eve of my second year as president of the Columbia University School of Nursing Alumni Association. I am honored to continue serving in this role and eagerly anticipate welcoming alumni back to campus in early May at Alumni Reunion. I also look forward to the opportunity to speak to the Columbia Nursing Class of 2014 later in the month and congratulate hundreds of graduates on their new alumni status. The Alumni Association was involved with a wide range of events during the past year: The sixth annual Welcome Breakfast hosted by the Alumni Association for new students at the Faculty Club was well attended. A new “Real Talk” series launched which featured recent graduates

speaking to current students candidly about life after Columbia Nursing. The Alumni Admissions Ambassador program also began this spring: Newly admitted Entry to Practice students received a message from me inviting them to connect with an alumnus/volunteer to answer questions during the critical window when applicants decide which nursing school to attend. And Suhanna De LeonSanchez ’06 ‘09, a recent grad, extended a welcome message on Visiting Day for accepted students on behalf of all Columbia Nursing alumni. The Alumni Association also sponsored three receptions during the 2013-2014 school year : A joint reception with the United Nations Population Fund; a celebration for Judy Honig, DNP, associate dean for student affairs, in honor of her installation in the Dorothy M. Rogers Chair; and a health care panel discussion and reception organized with the school’s Center for Health Policy. Our partnership with the Columbia Alumni Association (CAA) continues to grow. Columbia Nursing alumni participation and input were solicited and incorporated into the CAA’s five year strategic plan. The plan’s objectives include increasing and enhancing communication and opportunities for Columbia schools; collaboration between regional clubs, global centers, affinity groups and alumni; and

more engagement between Columbia University schools and the global alumni community. This partnership helps afford us opportunities to engage with Columbia Nursing alumni as well as interact in meaningful ways with graduates of other schools. For example, Columbia Nursing had a fruitful collaboration last fall with all the other CUMC schools on Giving Day when the school organized a lively panel discussion on the Affordable Care Act in tandem with the CAA. Columbia Nursing continues to partner with the CAA on other University-wide events. Michelle Kolb ’06 ’09 received the Richard E. Witten Award for Volunteer Leadership at The Trustees’ Luncheon at last fall’s Alumni Leaders Weekend. Later that night, Roxana Sasse ’92 ’11 was one of nine University honorees at the CAA’s Alumni Medalist Gala. I look forward to reconnecting and meeting with alumni across the generations at Reunion this spring, and at future events in the year ahead. Warm regards,

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2013-2014 CLASS AND PROGRAM NOTES 1940s Jean

Lagakis Benner ’42 sends her regards from Port Royal, South Carolina. Elizabeth Schoonmaker Booth ’42 has hung up her riding boots, but is still traveling. As a fomer Navy nurse, she was given the opportunity this year to take an Honor flight to Washington, D.C. Annette Fitch Donovan ’42 is active in several groups including a poetry club. She enjoys knitting and is proud of her four great grandchildren.

Doris Sawyer Jimison ’42 is very active and still driving. She spends her time playing bridge and enjoying her family. Irene Holtan Schmidgall ’42 is well and keeps busy by participating in her community and visiting her family. Marion Howald Swarthout ’42 has been keeping busy spending time with family and enjoys staying in touch with fellow classmates.

Barbara Tanis Fetzer ’42 is doing well and living in Stamford, Connecticut with her husband.

Frances Smith Caulo ’44 has been happily living at a retirement community in Hingham, MA since 2005. Her two daughters, Susan Caulo Purcell ’72 and Nina Caulo Feirman ’76, are also graduates of Columbia Nursing.

Martha Pearson Freeman ’42 is enthusiastic as ever and still driving her car.

Virginia Stanforth Stuart ’44 is residing happily in a retirement community at age

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92 and enjoys spending time with her three children.

is a very active volunteer in her community.

June Travers Werner ’45 worked with Dean Grace of Illinois College of Nursing to fold the diploma program.

June Abercrombie Hutchison ’49 worked as head nurse in the operating room at Presbyterian Hospital, supervising head, neck and maxillafacial surgery. She married Tom Hutchinson in 1954. She taught emergency preparedness classes for Suffolk County, New York Civil Defense, the practical nurse program in the Loudon County and Virginia public school system. She was active in Girl Scouts for over six decades and sings in the Loudun Chorale.

Anita Siegel Epstein ’46 retired from the American Cancer Society in 1991 and volunteers at several community organizations while living comfortably in a senior retirement community. Elizabeth Raimet Bechtel ’49 worked in public health nursing and taught in nursing schools for a number of years after graduation. In 1961, she moved to Valdosta, Georgia and taught in the Biology Department at Valdosta State College, which is now Valdosta State University. In 1972, Elizabeth was the first woman elected to Valdosta City Council and served 10 years, two as mayor pro-tem. Elizabeth is now retired and

1950s Eva Wohlauer Rollnik ’50 writes from Hilton Head, South Carolina where she is enjoying retirement with her husband Morton.

Rachel Content Fields ’51 celebrated her 60th wedding anniversary with her husband and family in February.

and sponsors of the “Tastings for Gift of Life,” a life-saving, pediatric cardiology surgery program.

Marilyn Johnsen Hamel ’51 is doing well and enjoys keeping in touch with her fellow alumni. Alice Daly Thomas ’51 is well and celebrated her 60th anniversary with her husband last year. Barbara De Vecchi Klauber ’53 fondly recalls working in the OR from her graduation in 1953 until 1960. She is well and lives in Naples, Florida. Marilyn Miller Stiefvater ’54 received the Realtor Emeritus award from the National Association of Realtors in recognition of her 40 plus years of service and still works as a realtor.Marilyn and her son were selected by the Rotary Club of the Pelhams as honorary chairs

Marilyn Miller Siefvater ’54 received Realtor Emeritus award

Barbara Scrivens Amatruda ’57 lost her husband in 2010. She is doing well and is becoming more mobile with the help of her Old English sheepdog.

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Geraldine “Geri” Golden Allerman ’57, Sarah Swick Becker ’56, Gloria Agaston Bruno ’57, Lenore Kafka Hardy ’56, Nancy Fixler Houseworth ’56 and Teresita Maxwell Leonard ’57 attended a lunch in Deerfield Beach, Florida with Dean Bobbie Berkowitz in January.

Brenda Barrowclough Brodie ’65 has a new granddaughter — Dahlia Constance Brodie — who was born in January in New York City.

1970s Ellyce (EJ) Engle Charles ’74 continues to work as the lead school nurse in a public school district which is 95% Native American and located on a reservation.

1960s

Barbara Desch Lenihan ’74 was promoted to Regional Clinical Liaison at Benchmark Senior Assisted Living in Wellesley, Massachusetts.

Constance “Connie” Crisci Corwin ’64 recently retired. She attended a lunch with other area alumni in Deerfield Beach, Florida with Dean Bobbie Berkowitz in January.

Jeri Bigbee ’75, adjunct professor at the Betty Irene Moore School of Nursing, attended a lecture given by Dean Berkowitz at UC Davis in February.

Mary Masterson Germain ’64 was awarded an honorary Doctor of Science degree at SUNY Downstate last year. Mary Turner Henderson ’64 hosted a gathering for Dean Berkowitz and Bay Area alumni in her home last November. Margaret Mabrey Craig ’64 also attended.

Dahlia Constance Brodie

Betsy Kerr Hay ’67 and Molly Marsden Schneider ’67 reunited after discovering they both lived in Nashville, Tennessee. Both are retired from nursing and are members of the Herb Society of Nashville. They are celebrating their renewed friendship. Midge Harrison Fleming ’69 is pleased to announce the engagement of her son Alex.

Jill Nadolny Kilanowski ’77 ’82 was selected as an inductee of the Fellows of the American Academy of Nursing.

last three years, she has worked as a clinical nurse for Arbor Pharmaceuticals, LLC. Leah C. Morris ’79, nurse practitioner with Yolo Hospice in Davis, California, attended a lecture given by Dean Berkowitz at the Moore School of Nursing at UC Davis in February.

1980s Ellen Soley Adkins ’81 received a DNP last year from the University of South Carolina. Ellen and her husband, Stan, have three children, and proudly celebrated their son Nick’s graduation from Princeton University last year.

Christina Alvarado Shanahan ’81 joined Blue Cross/Blue Shield of North Carolina in 1994 as director of Public Policy & Regulatory Affairs. She served as staff director of the U.S. House Subcommittee on Hospitals and Health Care and as professional staff member of the U.S. House Committee on Veteran Affairs from 1989 to 1994. She was selected for promotion to Rear Admiral, US Navy. She serves as deputy commander Navy Medicine East, Nurse Corps.

Patricia M. Ruiz ’86 received a post-Master’s certificate from University of Pennsylvania School of Nursing in 2000. In 2012, she worked at Rutgers University School of Nursing where she planned, implemented, and evaluated an evidencebased depression screening program. She is the director of Clinical Affiliations and Career Development at Seton Hall University College of Nursing.

Pennie Sessler Branden ’85 earned a PhD from Villanova College of Nursing. Carol F. Roye ’86 wrote A Woman’s Right to Know, a book about how women’s health devolved from a medical issue to a political one.

Roxanne Guiness ’78 left hospital nursing more than 20 years ago and moved to industry, mainly selling medical devices for the operating room. For the Children of Ellen Soley Adkins ’81 celebrate her son Nick’s graduation from Princeton University in 2013

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studies Irish Gaelic at the Irish Arts Center in Manhattan.

PROGRAM NOTES Adult-Gerontology Acute Care Nurse Practitioner Program (formerly Acute Care Nurse Practitioner) Marianne Baernholdt ’94 oversees the Rural and Global Health Care Center at the University of Virginia School of Nursing where she also teaches. She was selected as an inductee of the Fellows of the American Academy of Nursing last year.

Joan Ostrander Valas ’90 ’91 ’95 wrote a chapter on ethical considerations in the care of vulnerable adult populations in Ethical and Legal Issues for Doctoral Nursing Students: A Textbook for Students and Reference for Nurse Leaders.

Adult-Gerontology Primary Care Nurse Practitioner Program (formerly Adult Nurse Practitioner) Janica Barnett ’10 ’13, Debbie Dubeansky ’10 ’13, Josh Raufman ’10 ’12, Kathy Wu ’10 ’12, Martha Yepes ’11 ’13, and Annie Yu ’08 ’13 spoke about their career paths since graduation in a panel discussion organized by program director Jeffrey Kwong.

Marianne Baeroholdt ’94, FAAN inductee

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Paige Mackey Bellinger ’10 ’12 spoke at Columbia Nursing’s “Real Talk,” a

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Doctor of Nursing Practice

Julie Lindenberg ’07, associate professor of Clinical Nursing at The University of Texas Health Science Center School of Nursing, was named Clinical Quality Manager, a newly created position, at RediClinic. Julie serves on the Texas Health Services Authority Statewide Collaborative Planning Process: Electronic Health Record Adoption and Consumer Engagement work group, the American College of Nurse Practitioners Practice Committee, The Convenient Care Association Clinical Advisory Board, and the American Board of Comprehensive Care Board of Directors.

Norma Hannigan ’07 is now a clinical professor of nursing at Hunter CollegeBellevue School of Nursing. She celebrated her 10th year writing a health column for 10-4 Magazine, a publication read by truck drivers. She sings with Jasper Glee at Manhattan College, and

Rachel Cintolo Lyons ’07, assistant clinical professor, is the Pediatric Nurse Practitioner specialty director at Rutgers University School of Nursing. She maintains a clinical practice at Newark Beth Israel ED and Hasbro’s Children’s Hospital in Rhode Island. She presented a

candid discussion with students about life after Columbia Nursing. Kristine Takamiya ’01 ’07 moved to Seattle with her family last year, and is now a clinical associate professor at the University of Washington School of Nursing. Kris reports she is enjoying her new work, but misses New York City. Virginia Ranitovic Rudd ’95 ’98 ’07 had her poem Invisible War published by Oncology Times.

poster at the Annual National NAPNAP conference outlining her program for active video gaming and nutrition education for fifth graders at the Greater Newark Charter School. Clare Cardo McKegney ’08 recently moved from the Boston area to Summit, New Jersey, and works at in a large private practice. Clare launched a new business, thesavvyparent.com, offering classes on newborn care, nutrition, safety, vaccines, and breastfeeding. Courtney Reinisch ’07 wrote a chapter in Ethical and Legal Issues for Doctoral Nursing Students: A Textbook for Nurse Leaders. Julie Schnur ’03 ’05 ’13 was an author of “Girl, 13 With a Bump on her Leg,” published in Clinician Reviews. Jennifer Smith ’05 was an editor and chapter author of Ethical and Legal Issues for Doctoral Nursing Students: A Textbook for Nurse Leaders.

Entry to Practice Program John Menzies Godfrey ’94 has been publisheding poetry collections since 1971. He worked as head nurse in a clinic at Kings County Hospital Center from 2003 until his retirement in 2011.

Family Nurse Practitioner Program Samantha Ashley Armstrong ’08 ’11 married Grant Andrew Blosser in Clinton, NY last year. Sara Buros ’09 ’11 and Rebecca Mizrachi ’10 ’12 spoke at Columbia Nursing’s “Real Talk,” series of candid discussions with students about life after Columbia Nursing . Melissa Rodriguez-Ramos ’02 ’04 works as a faculty member at the Helene Fuld College of Nursing and represented Columbia Nursing at the Helene Fuld School of Nursing presidential inauguration in 2013.

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Nurse Anesthesia Program Laura Ardizzone ’04 ’10 was appointed to the National Quality Forum’s Patient Safety Steering Committee. Donald R. Boyd ’06, a current PhD candidate, was selected as a 2013 Jonas Nurse Leader Scholar. He was also featured in a poster for National Nurse Anesthetists Week.

Roxana Sasse ’92 ’11 was one of 10 Columbia University graduates who received the 2013 Alumni Medals at last October’s Medalists Gala organized by the Columbia Alumni Association. Roxana recently facilitated the establishment of a Columbia University Columbia Club of Rhode Island. She volunteers as a Columbia Nursing admissions interviewer, and works as a CRNA at Roger Williams Medical Center in Providence, Rhode Island. She is an associate editor for Columbia Nursing’s Clinical Scholars Review: The Journal of Doctoral Nursing Practice.

Donald R. Boyd ’06 with Patricia Horoho, US Army Surgeon General

Janice Jones Izlar ’06 completed her term as president of the American Association of Nurse Anesthetists (AANA) last year. She focused on scope of practice and other important issues for CRNAs.

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George Van Amson, CAA Chair University Trustee Emerita, Roxana Sasse ’92 ’11 and Jacqueline A. Bello, 2013 Chair, CAA Honors & Prizes committee

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Nurse Midwifery Program Karla Silverman ’98 ’01 attended the 2013 Welcome Breakfast for new students hosted by the Alumni Association last June. She lives in New York City with her husband and two daughters and is senior program manager at the Primary Care Development Corporation.

PhD Program Michelle Gellman Appelbaum ’07 was named Nurse Practitioner of the Year by the Nurse Practitioner Association (NPA) of New York State. Michelle has served as the president of the Greater Newburgh Chapter of the NPA since 2011 and has written and published articles in various nursing research journals. Sharron Close ’01 ’03 ’09 ’11 and Pamela Blythe de Cordova ’09 ’11 were named 2013 Emerging Scholars by the Bloomberg faculty of Nursing at the University of Toronto.

Sarah A. Collins ’09 was recognized as a 2012 Emerging Nurse Leader by the Alliance for Nursing Informatics.

Jeannie Cimiotti ’04, Anita Nirenberg ’09, and Kristine Qureshi ’03 were selected as 2013 Fellows of the American Academy of Nursing.

Nicole Faerman Geller ’11 ’13 and Mary Ann Witt ’95 ’07 will present findings from their Alpha Zeta chapter Sigma Theta Tau-funded research projects at NewYork-Presbyterian affiliated hospitals during National Nurses Appreciation Week this spring.

Njoki Ng’ang’a ’13 was a speaker at a reception sponsored by Columbia Nursing’s Alumni Association and co-sponsored by Friends of the United Nations Population Fund in 2013.

Lorie Goshin ’10, Ann-Margaret Navarra ’92 ’10 ’11 and Barbara Sheehan ’10 spoke at Columbia Nursing’s “Real Talk: PhD,” a candid discussion about career opportunities for PhD nursing grads.

Olivia Velez ’06 ’11 gave birth to a son, Alejandro Velez-Benenson, in 2012. He “walked” down the aisle with her at Commencement 2012 in his baby-carrier. Olivia has also been named an Emerging Nurse Leader by the Alliance for Nursing Informatics (ANI).

Njoki Ng’ang’a ’13 at Columbia Nursing Alumni Association reception

Victoria Tiase ’06 was named an Emerging Nurse Leader by the Alliance for Nursing Informatics.

Lorie Goshin ’10, Ann-Margaret Navarra ’92 ’10 ’11 and Barbara Sheehan ’10 spoke at “Real Talk: PhD.”

Therapy Among HIV-Infected Youth,” published in Journal of the Association of Nurses in AIDS Care. She serves as assistant professor at NYU College of Nursing.

The son of Olivia Velez ’06 ’11

Ann-Margaret Dunn Navarra ’92 ’10 ’11 co-authored “Health Literacy and Adherence to Antiretroviral

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In celebration of the DNSc-PhD conversion, newly conferred alumni of the PhD program raised more than $10,000 for the 2013-2014 Annual Fund to support scholarships for two Columbia Nursing PhD students.

Pediatric Primary Care Nurse Practitioner Program Tara Helene Geist ’05 completed her post-Master’s certificate in nursing education at Villanova University College of Nursing. Michelle Kolb ’05 ’09 received the Richard E. Witten Award for Volunteer Leadership at the Columbia Alumni Association’s Leadership Weekend in 2013.

Martha Cohn Romney ’81 and her husband Benjamin celebrated the wedding of their daughter, Ari, last summer.

Susan Patel Furlaud ’09 ’12 hosted the Annual Psychiatric Mental Health Nurse Practitioner Alumni Reception on November 4, 2013.

Psychiatric Mental Health Nurse Practitioner Program Jeannemarie Gelin Baker ’90 received the 2013 Norman Vincent Peale Award for Positive Thinking Award. Suhanna de Leon-Sanchez ’06 ’09 addressed newly admitted students at Visiting Day this year and encouraged them to enroll at Columbia Nursing. She works at Memorial Sloan Kettering Cancer Center and also has a private practice in Brooklyn.

Save the Date: November 7-16: Dean Berkowitz will lead a nursing delegation to Vietnam, open to alumni and friends of Columbia Nursing. Bill Campbell, Co-Chair, the Trustees of Columbia University; Michelle Kolb ’05, ’09; Larry Lawrence; and Lee Bollinger, President, Columbia University

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For more information, please visit http://bit.ly/NursingVietnam

ALUMNI ADMISSIONS AMBASSADORS 2013-2014 Alumni admissions ambassadors connect with accepted applicants to give their perspective as recent graduates. Columbia Nursing alumni ambassadors not only share their experiences and information about Columbia Nursing, but also help personalize the admissions process for candidates each year. If you are a Columbia Nursing alumnus who has graduated within the last 10 years and would like to become an admissions ambassador, please email nursingalumni@columbia.edu. Vanessa Battista ’06 ’08 Monica Buff Burrell ’09 ’12 Bernadette Capili ’96 ’02 Julia Chan ’10 ’12 Suhanna de Leon-Sanchez ’06 ’09 Kimberly Garruto ’07 ’11 Mara Iaconi ’10 ’12 Matthew Jenison ’10 ’12 Judith Jones ’08 ’09 Michelle Kolb ’05 ’09 Allison Ledwith ’12 ’13 Paige Mackey Bellinger ’10 ’12 Margaret Leeves Martin ’10 Rebecca Mizrachi ’10 ’12 Erik Morris ’10 ’12 Ann-Margaret Navarra ’92 ’10 ’11 Elizabeth Ong ’09 ’11 Roxana Sasse ’92 ’11 Kathy Wu ’10 ’12

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Giving Day Columbia Nursing raised $46,000 (including a University Trustee bonus) for scholarships, an increase of 50 percent from the 2012 Giving Day total. Thank you to all volunteers and donors for making the day a success! Save the date: Columbia Giving Day 2014 - October 29. To join the 2014 Columbia Nursing Giving Day committee, please contact Janine Handfus at jh2526@columbia.edu.

Columbia Nursing Giving Day Committee Co-Chairs: Michelle Kolb ’05 ’09 and Wanda Montalvo, PhD candidate Laura Ardizzone ’04 ’10 Vanessa Battista ’06 ’08 Don Boyd ’06 Monica Buff Burrell ’09 ’12 Susan Doyle-Lindrud,’94 ’08, assistant dean William Enlow ’04 ’10 assistant professor Mollie Finkel ’11 ’12 Sunni Levine ’96, clinical placement director Jeffrey Kwong, director, Adult-Gerontology Nurse Practitioner Program Roxana Sasse ’92 ’11 Olivia Velez ’06 ’11

Columbia University School of Nursing Board of Visitors Brenda Barrowclough Brodie ’65 Durham, North Carolina

Mary Turner Henderson ’64 San Francisco, California

Robert Brook, MD, ScD RAND Corporation Santa Monica, California

Karen Ignagni America’s Health Insurance Plans Washington, DC

Gene Budig Distinguished Professor, The College Board New York, New York

Janice Izlar ’06 The Georgia Institute for Plastic Surgery Savannah, Georgia

Frannie Kelly Burns ’77 Greenwich, Connecticut

Robert L. Kane, MD University of Minnesota Minneapolis, Minnesota

Delphine Mendez de Leon ’78 Huron Consulting New York, New York Angela Clarke Duff ’70 Forest Hills, New York Phyllis R. Farley New York, New York Marjorie Harrison Fleming ’69 Chair Princeton, New Jersey Karen Hein, MD Jacksonville, Vermont

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Delphine Mendez de Leon ’78 Huron Consulting New York, New York Duncan V. Neuhauser, PhD Case Western Reserve University Cleveland, Ohio Nicholas A. Silao ’90 Anesthesia Providers New York, New York Sara Shipley Stone ’69 Brooksville, Maine

Kenneth W. Kizer, MD University of California, Davis Health Systems Sacramento, California Mary Dickey Lindsay ’45 New York, New York Elizabeth J. McCormack Rockefeller Family and Associates New York, New York Phyllis D. Meadows, PhD University of Michigan Ann Arbor, Michigan

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Losses in our Community Ayanna N. Ade ’89 Kate Wilbur Amsden’41 Milton A. Ausman ’86 Karen Gwin Barger ’63 Helen Brandt Battiste ’60 was a registered nurse working in behavioral health for 50 years, and was an early pioneer in hospice nursing. She retired from her position as nurse case manager from Carondelet Hospice in 2007. Helen passed away at age 76 this year.

was a pioneer in working for non-discrimination of gays and lesbians in public health nursing. She volunteered at community radio station WOMR of Provincetown, Massachusetts where her programs featured women in music and contributed to the International Alliance for Women in Music. She was a very active volunteer with Southeastern Guide Dogs. Jeanne passed away in last year at age 78.

Janet Graham De Araujo ’53 Marion Waldner Deas ’43 Virginia Anderson DeLuke ’42 Anne Westmaas Dingman ’55 Kathleen Tyner Dinsenbacher ’64 Vaughn Dickson Early ’43 served in the Navy Nurse Corps for two years during WWII and continued nursing for many years in the United States when she returned. Vaughn passed away at 93 last year in Vista, California.

Dorinda Bell Burrows ’42 Amelia S. Eiseman ’44

Carol Cooke Beal ’44 worked as a dedicated registered nurse at Lewis Co. Extended Care Facility in Lowville, NY from 1980 until she retired in 1993. In 1991, she was selected by the New York State Legislature to receive the Nurse of Distinction Award. She served as a Sunday school church teacher and volunteered for many organizations including the Blood Mobile and Dodge Pratt Northam Art. Carole passed away in Boonville, New York last year. Frances Davis Becker ’58 Marjorie Jean Childs Black ’45 Elizabeth C. Bliven ’42 Jeanne Luanna Brossart ’73 served on the faculty at Columbia Nursing for many years and

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Doris Joyce Campanella ’50, a former actress, singer, and registered nurse, passed away peacefully at age 84 last year. She performed with the Metropolitan Sextet in the 1950’s and in 1961 toured with Gower Champion’s Tony-Award-winning production of Bye Bye Birdie. Joyce also worked as a school nurse in New Jersey from 1974-1992 where she also served as the director of the annual school musical.

Barbara Herrin Ertel ’55 served as the clerk of a precinct in Connecticut where she also volunteered with Meals on Wheels and was an active member of the Daughters of the American Revolution. She loved traveling, playing golf, camping, and entertaining friends and family. Barbara passed away at age 81 in Florida this year. Helen Anson Gamble ’48

Lydia Winslow Carroll ’63 Lucille Prior Clark ’45 Maryanne Costa ’06 ‘09 Gwendolyn Hines Costello ’48 ’68 Janet S. Cowern ’54 Sarah Louise Crawford ’34 Jane Bauer Cruthers ’39 Harriet Tilton Daams ’48

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Ellen Croke Geraghty ’57 worked as a home health care coordinator at St. Agnes Hospital in White Plains and later as a Westchester County visiting nurse. She was married to Phillips Robert Geraghty for 39 years. Ellen passed away last year.

Gladys Swayze Gies ’28 Gertrude Whiteford Godfrey ’44 Virginia Anderson Gorosh ’69 Virginia M. Green ’40 Jean Falist Gremse ’39 Mary Ogden Hall ’40 Shirley Clarke Hall ’61 Marjorie Brook Harding ’46 Marilyn D. Harrison ’70 Betty Jane Bartholomew Henzel ’52 Elizabeth Price Hinson ’36 Anna Deyo Howerton ’54 Patricia A. Hummel ’46 Elizabeth Jennings Lyons ’39 Elaine Fox Jones ’63 Margaret Gunn Kane ’41 Jane Rilance Keefer ’62 Patricia George Kempton ’54 was an active humanitarian, involved in the founding of the Danville Health Center in Vermont, holding all roles in the Peacham Women’s Fellowship, and serving as a Justice of the Peace for several years in Peacham, Vermont. She was also involved with her local HeadStart, and served as a mentor for students in her hometown area. Patricia passed away peacefully last year at age 81. Jeanette Helms Koehnken ’43 Mary Ruth Foley Kohlmann ’38 Sheila Sax Lacey ’60 Natalie B. Lass ’32 Grace E. Laubach ’53 Dorothy Reichling Loranger ’36 Marjorie Coble McDaniel ’53 Laurie Suzanne McGill ’05 Arla Mellen Middleton ’53 Charlotte Alice Muldoon Moyes ’58 Elizabeth C. Muchmore ’52 Jane Wichert Muller ’60 Margaret Murphy ’82

Judith Taylor Murray ’72 Eleanor Morris Nicholson ’55 Mary Bright Noyes-Martin ’67 Florence T. O’Grady ’61 was very active in politics throughout her life and worked in the New York City school system before retiring. She was a parishioner of St. Gregory’s church in Harrison. Florence passed away at age 87 last year. Anne Elizabeth B. Orr ’49 Maude White Parker ’44 Barbara Pelligrini ’79 Olga Peters ’57 Gwen McCahan Pfaeffle ’65 Mary Ann Lilster Pomeroy ’47 Olive B. Powell ’49 Lillian Schuttger Price ’43 worked at Pittsford Central School for 21 years in her hometown of Pittsford, New York. During her years in retirement, Lillian enjoyed traveling and was very active in her church. In addition, she was a founding member of a resident produced publication which she edited for ten years. Lillian passed away at age 96 this year. Cathy Lee Christy Reese ’82 Barbara Moulden Reid ’64 Mathilda R. Rider ’34 Linda D. Robinson ’58 Sheryl Palma Barker Slate ’70 Helen Virginia Bunn Smith ’43 Eleanor R. Speer ’57 Anna Moulton Sirch Spitznagel ’47 Frances Holub Svetz ’52 Harriet K. Talbot ’48 Ruth H. Teillon ’37

Gloria Beach Tenney ’51 considered her time at Columbia Nursing the happiest and most treasured part of her life and was proud to be associated with such a wonderful group of accomplished women. She passed away last year. Jean Acomb Van Landingham ’43 Victoria S. Wald ’78 Joan Mirandon Walther ’51 Jennivieve Tootell Westwick ’42 Mary Soranno Wilt ’40 was instrumental in creating Shelters for Battered Women and Children in exurban Livingston County. She worked as a nurse at various hospitals throughout her life and when she received a BA degree from Empire University in 1987 she was honored for being the school’s oldest diplomat. Mary passed away peacefully in Pennsylvania at age of 96 last year. Nancy Dunn Wolcott ’44 Marion Clark Wood ’46 Edith Royce Zaager ’57 entered the U.S. Air Force as a nurse in 1959, became an instructor, and eventually retired as a captain. She spent much of her later life as an avid golfer and collector. Captain Zaager passed away this year and was given a funeral ceremony with full military honors. Please notify the Office of Development and Alumni Relations at (800) 899-6728 if you learn of the death of a fellow alumnus.

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Plan Your Legacy

Keep up with Columbia Nursing News and Events!

Edith Royce Zaager ’57 (center) receiving military honors in 1965

Support the next generation of Columbia Nursing students Edith Royce Zaager ’57 understood the importance of a great education and the opportunities that it can bring. Columbia Nursing gave her the independence to follow her dream of helping people. After graduating, Zaager entered the United States Air Force as a nurse. She worked as an instructor and served her country as far as Japan, retiring as a Captain. Edith was the ultimate teacher, even in her final days, when she mentored the nurses caring for her.

Edith and her family wanted to give back to the the school that was a stepping stone for her career. Edith wanted to not only educate the next generation of nurses but to empower them. The donation will support students scholarships, the student travel fund and the school’s new building. Edith was a true trailblazer in every sense of the word. She forged her own path throughout her life. Her generosity will enable future nurses to pave their own way.

Will you consider making Columbia Nursing part of your legacy? For more information about planned giving, please contact Janice Rafferty at jar2272@columbia.edu or 212.305.1088. 52

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Then & Now:

Myrna Lee Bergman ’68, right, looks over a patient chart with a nurse.

Columbia Nursing students reviewing patient charts during their clinical rotations.

Image courtesy Archives & Special Collections, Columbia University Health Sciences Library

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The Academic Nurse Spring 2014