Voice magazine, fall 2023

Fall 2023

Treating and preventing

tuberculosis

in rural South Africa

from the dean Dear friend, Nursing is an increasingly dynamic profession. We take on the big challenges in our local communities and across the globe, and answer the call for and find novel solutions to the world’s increasingly complex health care needs. We do this through knowledge, compassion, dedication, expertise, and our deep commitment to the well-being of others. We do this because that’s what the world needs.

At Boston College, we take immense pride in our nursing programs and the remarkable contributions of our students and alums. Here in the fall 2023 issue of Voice, you will read about our Mary Mahoney Program, which builds community and helps support graduate students of color and first-generation students in an accelerated, two-year master’s program. You will learn how Assistant Professor Brittney van de Water is finding new ways to achieve health equity by implementing better tuberculosis care practices in rural South Africa. And you will meet our newest faculty members, including Diana Bowser, CSON’s new associate dean for research and integrated science and one of the first health economists to join the faculty of a U.S. school of nursing.

dean Katherine E. Gregory

editors John Shakespear Kathleen Sullivan

managing editor Tracy Bienen

art director Diana Parziale

graphic designer Christine Hunt

contributors Tracy Bienen Steven Constantine Nathaniel Moore Brendan Ruberry Debra Bradley Ruder John Shakespear Kathleen Sullivan

photographers Caitlin Cunningham Lee Pellegrini

The articles in this magazine shed light on the incredible work— the inspiring work—of nurses and their ability to effect meaningful change. I hope these stories inspire you and fill you with hope for the transformative power of nursing in health care today.

Sincerely,

katherine e. gregory Dean

Sophie Smith Chris Soldt

Voice is published by the William F. Connell School of Nursing and the Boston College Office of University Communications.

Address letters and comments to: csonalum@bc.edu Associate Director, Marketing and Communications William F. Connell School of Nursing Maloney Hall 140 Commonwealth Ave. Chestnut Hill, MA 02467

Baccalaureate and direct entry master’s degree programs have full approval by the Massachusetts Board of Registration in Nursing.

CCNE Accredited 2018–2028

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contents

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Fall 2023 neWs

2 CSON ranked #10 in U.S. News & World Report undergraduate rankings, Pinnacle lecture focused on global public health, faculty and students awarded research grants, and alumna named a Living Legend

features

4 Treating and preventing tuberculosis in South Africa Assistant Professor Brittney van de Water is finding new ways to achieve health equity

8 In the footsteps of a nursing pioneer The Mary Mahoney Program welcomes its first cohort of master’s students

achieVements

12 An economic lens on health systems Meet Associate Dean for Research and Integrated Science Diana Bowser

14 Welcoming our new faculty Five accomplished nurse-scholars join the Connell School this fall

16 Faculty publications Research on hypogonadism and reproduction, nurses’ ethical obligations to unvaccinated individuals, and predictors of fertilityawareness-based method use

17 Faculty presentations Expanding nutrition education in nursing schools, couples’ perceptions of health and family decisionmaking, and post-NICU care for high-risk infants with dysphagia

bc.edu/voice IMAGE CREDITS Cover illustration, Christine Hunt; Back Cover, Lee Pellegrini; Left, Caitlin Cunningham; Above, clockwise from top left, Christine Hunt, National Women’s History Museum, Christine Hunt and iStock.com/anilakkus, Lee Pellegrini

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news Research

Amy Goh

Alumni Doctoral candidate Amy Goh was awarded a National Institutes of Health F31 grant from the National Institute of Nursing Research for the project “Respectful Communication and Patient Portal Usage in Pregnant People of Color.”

Associate Professor Tam Nguyen and her team were approved for funding from the PatientCentered Outcomes Research Institute (PCORI) for their study “Measurement Matters,” which will develop a measure to assess patients’ engagement with research and how it might affect health outcomes. Nguyen is the Strakosch Family Faculty Fellow in Community Health.

Melissa Uveges

The International Society of Nurses in Genetics awarded Assistant Professor Melissa Uveges a grant for her research proposal “FamilyLevel Determinants of Heterozygous Familial Hypercholesterolemia Cascade Screening.”

Assistant Professor Brittney van de Water is the first CSON nurse scientist ever to receive a Child Health Research Award from the Charles H. Hood Foundation. The award supports a study aimed at improving outcomes for children diagnosed with tuberculosis in South Africa.

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Denise Charron-Prochownik, M.S. ’82, was inducted into the Sigma International Nurse Researcher Hall of Fame. She is a professor and chair of the Department of Health Promotion & Development at the University of Pittsburgh School of Nursing.

Martha A.Q. Curley, Ph.D. ’97, was named an American Academy of Nursing Living Legend during the AAN’s 50th anniversary year.

Martha A.Q. Curley

Students Ph.D. candidate Nickie Burney and D.N.P. student Cheryl Slater were awarded scholarships from the Nurses Educational Funds (NEF).

Burney received the NEF/Johnson & Johnson 2023 Health Equity Scholarship, and Slater received the 2023 Madeline A. Naegle Scholarship.

Nickie Burney

Cheryl Slater

Burney and CSON senior Anna Laytham ’24 were among the coauthors of “Cognitive Change Among Nursing Home Residents: CogRisk-NH Scale Development to Predict Decline,” an article in the Journal of the American Medical Directors Association. Professor Elizabeth Howard, CSON’s associate dean of Academic Affairs and Faculty Development, was also a coauthor.

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U.S. News & World Report ranked the Connell School 10th out of 654 schools in its 2024 Best Undergraduate Nursing Programs survey.

Faculty

Events

Professor Ann Burgess was the keynote speaker for the Academy of Forensic Nursing’s National Conference in November.

In June, the 2023 NANDA International Conference was hosted at Boston College. The topic—Shaping, Informing, and Communicating Nursing and the Human Experience—celebrated 50 years of the organization’s work in nursing practice, research, educational curricula, and informatics.

Associate Professor Andrew Dwyer is a 2023– 2024 Virtual Visiting Professor in a Johns Hopkins School of Medicine program called Health Humanities and Health Systems Science Distinction Tracks: Generating a Guild of Authentic Citizens in Healthcare.

Leah Gordon

Leah Gordon, CSON’s associate dean for inclusive excellence, diversity, and belonging, was accepted to the 2024 American Association of Colleges of Nursing Diversity Leadership Institute.

Vanessa Kerry

Professor Karen Lyons was elected to the board of directors of the Gerontological Society of America— the nation’s largest interdisciplinary organization devoted to the field of aging.

The American Nurses Association appointed Associate Professor of the Practice Aimee Milliken to the panel that is drafting the 2025 Code of Ethics, a critical initiative revised every 10 years.

Assistant Professor Monica O’Reilly-Jacob was inducted into the American Academy of Nursing in October.

IMAGE CREDITS Opposite page, Peter Julian (Uveges), Penn Nursing (Curley), all others courtesy of their respective owners; Above, Lee Pellegrini (2)

The fall Pinnacle lecture was presented by Vanessa Kerry, MD, M.Sc., director of the Program in Global Public Policy and Social Change at Harvard Medical School, CEO of Seed Global Health, and special envoy for climate change and health at the World Health Organization. Kerry’s lecture was titled “From Pandemic Preparedness to Climate Change Resiliency, the Solutions Lie with Our Health Care Professionals.”

Visiting Professor Sang Hui Chu, from Yonsei University College of Nursing in Seoul, presented the talk “Complex PTSD in North Korean Defectors: Psychosocial and Biological Markers,” based on her research.

Boston College hosted the Sixth Annual Sigma Region 15 Nursing Research Symposium in October. The topic was Bold Innovations: Nurses Leading the Changing Health Care Climate.

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Treating and preventing tuberculosis in rural South Africa Assistant Professor Brittney van de Water is finding new ways to achieve health equity by nathaniel moore, photographs by sophie smith, illustrations by christine hunt

Few illnesses lay bare the inequities of the modern global health system like tuberculosis. In 2021 alone, the disease killed 1.6 million people worldwide, more than any other infectious illness besides COVID-19. These TB deaths, however, were concentrated in countries with high rates of poverty because most infections can be treated with antibiotics—and in wealthy countries, they have been for generations.

This means that the failure to reduce the disease’s death rates globally isn’t a scientific problem: it’s a policy problem.

Brittney van de Water, assistant professor at the Connell School of Nursing, hopes to better understand and address this inequity. She is studying approaches to implementing TB-care practices in order to discover which strategies actually work.

“I wanted to look at the problem through an implementation science lens to be as effective as possible in the pursuit of global health equity,” van de Water said.

Out of a population of about 60 million, 450,000 South Africans develop TB each year. Of those, 270,000 are coinfected with HIV, and some 89,000

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die annually, making the need for more effective care a critical matter of life and death. Van de Water explained that “almost every low-income country has a high incidence of TB, but in South Africa about 60 percent of tuberculosis cases are in people coinfected with HIV. That makes it a totally different and dangerous epidemic, and one that needs to be urgently addressed at a systems level.”

The recipient of an R01 grant from the National Institutes of Health/National Institute of Nursing Research, van de Water will work to improve global TB care through her project “Using the Systems

Analysis and Improvement Approach (SAIA) to Prevent Tuberculosis in Rural South Africa.” To figure out the most effective ways of delivering better care to people failed by the current system, van de Water is collaborating with clinicians and researchers in some of the most rural and impoverished parts of South Africa. Together, they’re looking to discover which public health interventions are failing—and which ones actually save lives.

THE OBSTACLES Rural South Africa is a challenging place in which to promote public health. Due in large part to the legacy of racial apartheid, many parts of the country had little to no access to schooling, infrastructure, or clean water until the mid-1990s. In the years since, development has remained slow and uneven, with many areas not receiving electricity until last year.

Unsurprisingly, then, tuberculosis care remains heartbreakingly inadequate: only 80 percent of South Africans currently infected with TB receive a diagnosis, and just 53 percent successfully complete treatment.

The prevalence of poverty and illness also inevitably changes the way clinicians care for patients. Van de Water said that her South African colleagues taught her two essential questions they ask when a patient presents at a hospital: “Where did you come from and how long did it take to get here? The answers to these questions reveal both how sick someone is and the startling realities of transportation for communities wrapped up in poverty.”

For example, if someone took a long time to cover a short distance, that tells the clinician something important about the patient’s current condition. This information also helps predict the likelihood of a follow-up visit—if a return is even possible when the rains come and turn dirt roads to mud.

But once a patient arrives at a hospital, the clinicians’ challenges have just begun. Even in hospitals achieving steadily better results on the other main challenges facing impoverished rural areas—HIV, maternal health, infant health—tuberculosis has been difficult to get under control.

Sometimes this is because people with tuberculosis show up with symptoms for something else, so they don’t get screened for TB. And sometimes patients who are properly diagnosed are not able to follow the course of treatment because of food instability or lack of access to other essential resources.

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THE CARE CASCADE

screening

evaluation

diagnosis

In short, van de Water explained, TB mortality rates remain stubbornly high—according to the WHO, untreated tuberculosis has a death rate of about 50 percent—because the global health community hasn’t figured out how to consistently deliver treatment that we know works to those most in need. “Instead, people are unnecessarily dying every day,” she said.

Unfortunately, simply knowing that clinics aren’t meeting the needs of TB patients doesn’t mean knowing how to fix the problem. In the past, well-intentioned outsiders have offered advice to clinicians on how to improve TB care, but these practices made sense in a different context. In rural South Africa, this counsel has yet to meaningfully improve outcomes for patients.

THE METHOD To address South Africa’s unique challenges, van de Water’s analysis of the health care system draws on techniques from implementation science, a field that she characterized as the study of “the uptake of evidence-based practices in regular everyday health care.

“This kind of research doesn’t take place in a highly controlled lab, but in the real world,” she explained. “It’s about understanding what makes it harder for something to be implemented, and what makes it easier.”

linkage to care

treatment

tb-free survival

In other words, her subject is not tuberculosis itself but TB care: at what stages in the treatment process are patients failed, and what barriers keep them from getting the care they need?

To find out, van de Water and her team are using a strategy called the Systems Analysis and Improvement Approach (SAIA), which draws on data to map the stages in the treatment process where patients fail to progress to the next step. She will work with 16 facilities in the Sarah Baartman District of South Africa’s Eastern Cape to identify these bottlenecks. “Then, using microinterventions or quality improvement projects, we help each clinic feel empowered to make improvements that they identify,” she said.

Van de Water and her team have identified six steps in the optimal “TB care cascade”: screening, evaluation, diagnosis, linkage to care, treatment, and tuberculosis-free survival. Each step represents a juncture in the treatment process where a patient might not progress—and an opportunity to rethink how each clinic operates. For example, one clinic may decide to screen all patients for TB, irrespective of symptoms, while another may work to alleviate local food insecurity.

Together with all 16 clinics, van de Water will implement what’s called a stepped wedge cluster randomized control trial. “Four clinics, or a cluster, start by implementing the project, which they’ll execute for 18 months,” van de Water explained. “The next cluster of four clinics starts three months after the first, and the next three months after that.” This design helps researchers zero in on variables in contexts where controlled experiments are impossible and allows the intervention to have the widest reach.

...her subject is not tuberculosis itself but TB care: at what stages in the treatment process are patients failed, and what barriers keep them from getting the care they need?

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THE RESEARCH This early in the study, van de Water has no idea yet which interventions will prove most successful. For her, that uncertainty is part of the appeal because it rewards openness to diverse ideas. “I think this work requires a lot of buy-in from district health officials and clinic staff,” she said. “We’re not coming in and taking over to run TB care for five years. Instead, each clinic can come up with micro-interventions that work for them.”

This chance to draw on the collective expertise and creativity of so many people is part of what most excites van de Water. Her role, as she sees it, is to support them

Summer in South Africa Top: van de Water with students in her study abroad course, Global Health Delivery and Health Equity: A South African Context Bottom: Anna Laytham and van de Water review materials for the NIH-funded K23 project

Student collaborators Key to van de Water’s research is the support of CSON students such as Anna Laytham ’24, an undergraduate research fellow who worked in South Africa this summer supporting the research team. “I was monitoring whether contacts were screened and, if they’d tested positive, getting treatment,” Laytham said. “It was amazing to see what research really looks like on the ground, and the realities of the barriers that people—both patients and researchers—really face. It’s just so important to understand the local context.”

in what they do by providing necessary analytics. “As the saying goes, if something doesn’t get measured, it doesn’t get managed—period,” she said. “That’s why we’re here: to coach, guide, and measure with people who are seeing firsthand what really works.”

In recognition of the importance of improving global tuberculosis care and the excellence of her research, van de Water recently received a Hood Foundation Grant for her ongoing work on TB and post-TB care for kids. This research, which will also take place in South Africa, is part of her broader effort to help transform a global health system that is failing vulnerable people. Ultimately, she believes it’s necessary to change the way wealthier countries think about global health so that more people appreciate the importance of preventable and treatable diseases like TB. “I think that a lot of people in the U.S. think TB either doesn’t exist anymore or that we’ve fixed it or have a great vaccine for it,” van de Water said. “We haven’t, and we don’t. But we can provide evidence-based care for the people who need it the most if we choose to do the work and learn what really works. If we want to see a just system that offers universal access to care, it means starting with these fundamental basics of health care.” ▪

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In the footsteps of a

nursing pioneer The Mary Mahoney Program welcomes its first cohort of master’s students by brendan ruberry ’20

While Zina Aghdasi, a master’s student at the Connell School of Nursing, was completing a clinical rotation, there was a moment of confusion on the nursing floor. A young patient’s mother, who had immigrated from the Middle East, was insisting that they let her know before any males entered her daughter’s room.

The other nurses were surprised, but Aghdasi, whose own mother came from Iraq to the United States as a Bahá’i refugee in the 1970s, was able to understand this request in its cultural context.

“I felt like I had the ability to educate even more experienced nurses on the f loor about why this patient had this perspective,” Aghdasi said.

article on the topic. “There’s a broad body of research showing that it’s not just a nice idea for equity. It’s important for patient care.”

Her intervention is one small but meaningful example of how cultural alignment improves nursing care and health outcomes—as studies have proven again and again, according to CSON Associate Professor Andrew Dwyer.

In the wake of the COVID-19 pandemic, which led one in five professionals to leave health care and disproportionately impacted communities of color, the U.S. needs not only more nurses but more nurses from diverse backgrounds who are equipped to provide culturally informed care. Here at the Connell School, Aghdasi is part of a new program that aims to serve this pressing need by supporting graduate nursing students who identify as first generation and/or belong to a historically marginalized group.

“There’s great data showing that if there’s concordance between a provider and a patient’s self-identified race and/or ethnicity, the communication, relationship, and outcomes are more favorable,” said Dwyer, who coauthored a Reproductive Health

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“It’s not just enough to admit people.

If you don’t support them, it means nothing.”

–andreW dWYer, associate Professor

A FOUNDATION OF STUDENT SUCCESS Named for the first African American licensed nurse, the Mary Mahoney Program is designed to support these direct-entry students during their prelicensure coursework in pursuit of an accelerated master of science in nursing degree.

(Direct-entry students are those who have earned at least a bachelor’s degree in a field other than nursing.)

Initially launched in 2020 as a support resource, the program was developed into its current form by Anya Villatoro, CSON’s assistant dean of student services, diversity, and inclusion. She noticed a need to improve academic outcomes for direct-entry graduate students and a gap in the academic literature on how to improve such outcomes. Reviewing the data, she and Dwyer also saw that students from historically marginalized backgrounds were having unique challenges in the program.

In designing the Mary Mahoney Program— which welcomed its first cohort in the fall of 2022—Villatoro took inspiration from medical residency programs and Anya Villatoro the resources she has seen make a critical difference for students over her 12 years as a student affairs practitioner. She cited three pillars as integral to student success: mentorship, belonging, and support.

“It’s not about throwing down roadblocks and seeing who can get through, or some weeding out process,” said Dwyer. “That’s an old mentality.”

That said, the direct-entry program is challenging.

One first-semester class, Adult Health Theory, is condensed from two full-semester courses into one. Mahoney scholars juggle hours of classes, clinical rotations, and twice-weekly exams.

Many students work Andrew Dwyer part-time jobs and commute long distances to and from Chestnut Hill, and some are caring for young children or an older family member. “It’s not just enough to admit people,” said Dwyer. “If you don’t support them, it means nothing.”

Aghdasi, a certified lactation counselor embarking on a second career in nursing, likened the experience to teaching her three young children how to swim: “We were all in tears at the beginning. But you have to get over that fear of the water, just as you have to get over the fear of caring for other human beings.”

The first-year cohort’s experience included regular meetings with a faculty mentor, financial support for networking and NCLEX exam preparation, and a lunch Zina Aghdasi series highlighting various campus resources including the Wellness Center and Career Center. The lunch also provided space for students to form community and provide feedback on their experiences in the program.

Several Mahoney scholars said those lunch dialogues were critical to their formation as students and clinicians.

“They took our feedback seriously and brought it to the administrative staff,” said Aghdasi.

“How many programs allow a group of students to do that?”

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“Coming from backgrounds like mine, where no one is necessarily advocating for us, learning to Indiana Argant advocate for myself made it feel even more important to do that for others,” said Indiana Argant, D.N.P. ’26. “It felt like, ‘Okay, I’m not just a body in this cohort; I have a voice and I have power within that voice.’”

BUILDING A SUPPORT NETWORK Because the program is so rigorous and many students have outside commitments, Villatoro worried that Mahoney students might have difficulty forming the social networks conducive to success, especially without dedicated graduate student housing. The program’s cohort structure was designed to respond to that need.

“The cohort experience was probably the most successful aspect of the program,” said Villatoro, referring to the 10-student group of Mahoney scholars. Eventually, students began asking her to meet together more regularly, to discuss challenges such as imposter syndrome, or just to chat.

“My cohort has been very supportive,” said Jahi Tracy ’22, M.S. ’24, who was an undergraduate theology major and varsity fencer at BC. “That’s the thing I love about this program: we’re not afraid to share notes. We’re there for each other.”

Even after classes ended in May, those relationships held. “We supported each

Jahi Tracy

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other through our online summer classes,” said Argant. “We’re still meeting up via Zoom or FaceTime, doing assignments together, and studying together.”

“We’ve made lifelong friendships,” said Tracy. “That’s the really invaluable thing about this program.”

Despite coming from different backgrounds, the Mahoney scholars found common ground.

“They’re looking for a career that will have meaning and allow them to have a positive impact,” said Villatoro. “I think that’s the connective thread.”

As the son of a minister and a nurse, Tracy saw firsthand the value in service to others.

His mother’s work as a nurse motivated him to enter the field, which led to a passion for pediatrics. Now he’s mentoring the next cohort. “If they need help,” he said, “they can reach me.”

IMPROVING REPRESENTATION AND HEALTH OUTCOMES Mahoney scholars also shared a desire to improve representation in the profession. “As a first-generation Haitian American living in Massachusetts, I experienced and witnessed the barriers lack of diversity creates,” said Argant. “A profession that directly sought to address those issues really aligned with me.”

“We’re working with more and more diverse populations,” said Aghdasi. “We want to be able to bring in people with experiences and backgrounds that these populations share.

“When I meet an Afghan refugee, I see my mom,” she added. “I talk to them as if they’re my relatives, and there’s a sort of unspoken understanding about what they’re going through. It can help improve health outcomes when we understand each other better.”

“Realizing that I can be that agent of change that’s so desperately needed, and that I’m there, doing the work with the patients and making change in real time, is very motivating.”

–zina aghdasi, m.s. ’24

Aghdasi saw her status as a second-career nurse as an advantage rather than an insecurity. “We bring life experience that helps us meet the health care gaps that we are currently facing,” she said, citing her experience as a bulwark against possible burnout.

“It’s not just about learning the pathophysiology, pharmacology, and treatment plan,” said Dwyer.

“It’s also about how you bring yourself to the encounter and use yourself therapeutically to foster health, healing, and well-being. That’s what a great clinician will do.”

After the rigor of the first year, Mahoney scholars looked forward to the challenge of the second. “Right now, I’m in a place where, after surviving the first full year of the direct-entry program, I feel a lot more confident in myself and my abilities,” Argant said. “I’m really looking forward to continuing to grow.”

For Aghdasi, witnessing her family’s interactions with the health care system and inequities in her professional life have been a driving factor.

“Realizing that I can be that agent of change that’s so desperately needed, and that I’m there, doing the work with the patients and making change in real time, is very motivating,” she said.

“We’re forming clinicians who will value self-care and ref lection, and integrate those aspects into their daily practice,” explained Villatoro.

“Hopefully, that creates a ripple effect where they might be a model for how to create those spaces.”

“I’m excited for the future,” said Tracy. “I’m just excited to become a nurse.” ▪

IMAGE CREDITS National Women’s History Museum (Mahoney), Lee Pellegrini (Dwyer), Chris Soldt (Tracy), all others courtesy of their respective owners

about mary mahoney • Mary Eliza Mahoney was born to freed slaves in 1845 in Boston, Mass.

• As a teenager, she worked at the New England Hospital for Women and Children, known then for its all-women staff. Like some Mahoney scholars, she also worked other jobs, including as a janitor, cook, and washerwoman.

• In 1878, Mahoney was admitted to the professional graduate school for nursing at the New England Hospital for Women and Children, one of the first U.S. nursing schools.

• In 1879, Mahoney graduated, becoming the first professional African American nurse and an unheralded pioneer in the profession.

• Today, the American Nurses Association’s biannual Mary Mahoney Award recognizes “significant contributions … to integration within the nursing profession.”

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An economic lens on Meet Associate Dean for Research and Integrated Science Diana Bowser

by John shakespear photograph by caitlin cunningham

Every day, nurses and nurse practitioners encounter the socioeconomic and racial disparities inherent to health care systems—diseases that disproportionately impact many vulnerable populations, expensive treatments that not all patients can afford, and co-pays that can be burdensome even for the insured. These are the kinds of challenges that Diana Bowser, the Connell School’s new associate dean for research and integrated science, has spent her career working to address.

As a leading health economist who comes to Boston College after directing the Ph.D. in Social Policy at the Heller School for Social Policy and Management at Brandeis University, Bowser has worked in 23 countries, including the United States, evaluating their health systems to determine how policies impact patients and populations—and where needs go unmet. Now, as one of the first health economists to join the faculty of a U.S. school of nursing, she will work with CSON’s nurse researchers to blaze new paths toward more equitable and sustainable health care systems.

“Nurses are ideal clinical partners for studying health systems in various forms,” Bowser said. “They understand the symptoms at the bedside, and they know why patients are being readmitted, or why they aren’t taking their medication.

With their clinical knowledge, we can think collaboratively about how to make solutions work for entire systems.”

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health systems RETHINKING HEALTH SYSTEMS Bowser started thinking about the big picture of health care in high school, when a church trip to Honduras made plain the gulf between the resources available to her in Massachusetts and the care that most Hondurans could access. “That experience sparked my interest in public health,” she said, “though I didn’t think of it in those terms until later, since programs in public health were still rare.”

She went on to earn a master’s in international public health at Yale and a doctorate in health economics from the Harvard T.H. Chan School of Public Health. In the two decades since, she has worked with governments on five continents and organizations ranging from the World Health Organization to the World Bank. Her economics training enables her to bring a particular, data-driven perspective to issues such as health financing, resource allocation, income inequality, and evaluation.

“Most health care systems—not all, but most—are based on economic principles of supply and demand, on profits and margins,” Bowser explained. “If public health teaches you how to build good systems, economics can help you pinpoint why they are failing.”

Bowser has turned this lens onto some of today’s most urgent health challenges, including the opioid epidemic, COVID-19, and respiratory syntactical virus (RSV) cases among young children. By laying out the financial costs of treating these issues—and the often-starker costs of not treating them—her findings have informed important policy decisions, including the U.S. government and CDC’s recent decision to fund and prioritize RSV vaccinations for pregnant women.

At CSON, Bowser is excited to continue this work alongside clinicians and researchers who bring expertise across a spectrum of key clinical service areas, including preventive care.

“To solve the problems we’re facing, I think the way of the future—and the most costeffective way—is through prevention and primary care, where nurses play a major role. By marrying population public health to clinical experience, we can have a major impact on society.” ▪

IMAGE COLLAGE Christine Hunt, iStock.com/anilakkus, iStock.com/imaginima

Ahead of the pack Outside of work, Bowser is an avid—and fast—runner. In high school, she was the Massachusetts champion in the two-mile run, and she has competed in three Olympic Marathon Trials.

“Running has helped form who I am as an individual,” Bowser said.

“As a runner, you learn to set goals and do a lot of preparation to get to the finish line. You can apply those skills in anything you do.”

“If public health teaches you how to build good systems, economics can help you pinpoint why they are failing.”

—DIANA BOWSER

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Meet Connell’s

By Debra Bradley Ruder Photographs by lee pellegrini

new faculty

Five accomplished nurse-scholars joined the Connell School faculty this fall.

Bethany Croke

instructor

Focus: Family nurse practitioner caring for underserved populations Education: D.N.P. (expected 12/23) and M.S. ’11, family and community health, Boston College; B.A., Boston University Previous positions: Family nurse practitioner (2013–present) and FNP residency clinical manager (2021–2023), East Boston Neighborhood Health Center; guest lecturer, CSON (2021– 2023); adjunct faculty, Simmons University (2015–2023) Teaching: Family Primary Care Advanced Practice Nursing I*; Nursing Health Assessment Across the Lifespan Clinical Lab* Favorite pastimes: Running, cooking, being with husband and toddler

“My Jesuit nursing education directed me to serve vulnerable populations at community health centers.

But it’s exciting to be back in an academic setting.

In our profession, we never stop learning. Science is evolving, and nursing changes with it.”

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Sarah Given Assistant Professor of the Practice Focus: Adult palliative care nurse practitioner Education: D.N.P., executive leadership, Simmons University; M.S.N., adult and women’s health, MGH Institute of Health Professions; B.A., Mount Holyoke College Previous positions: Nurse practitioner in ambulatory palliative care (2018–present) and director of advanced practice nursing (2022–2023), Dana-Farber Cancer Institute; cancer clinical trials NP, Beth Israel Deaconess Medical Center (2016–2018) Teaching: Health Care Quality Management*; Nursing Leadership in Complex Health Care Settings*; Direct Entry Clinical Pharmacology* Favorite pastimes: Running marathons, baking, Junior League of Boston volunteering

“I’m working to ensure that patients with palliative care needs and substance use disorder receive compassionate and safe care. I hope to teach students how to communicate well with patients and families so they graduate as effective clinicians and communicators.”

For teaching, * indicates co-taught course

Katie Hutchinson

Associate Professor of the Practice, Program Director of Women’s Health Focus: Certified nurse midwife, educator, public health researcher Education: Dr.P.H., global health, Boston University School of Public Health; M.S.N., nurse midwifery, Yale University School of Nursing; B.A., Swarthmore College Previous positions: Assistant professor of obstetrics and gynecology (2019–2023) and co-director of OBGYN advocacy (2020–2023), BU School of Medicine, Boston Medical Center; instructor, BU School of Public Health (2022–2023); midwife and researcher on maternity care, BMC (2019–present) Teaching: Epidemiology Favorite pastimes: Family time, baking sourdough bread

“Providing excellent care to people in vulnerable situations drives my passion for midwifery, nursing, and health care, and my commitment to racial justice is essential to my work. Mentoring students who are learning to deliver care during one of life’s most transformative moments is so rewarding.”

Arlene McGuane

Instructor, Director of Clinical Learning and Simulation Centers Focus: Registered nurse dedicated to improving nursing education Education: Ed.D. (expected 5/24), nursing education, Teachers College, Columbia University; M.S., nursing education, SUNY Polytechnic Institute; B.S., nursing, Wagner College Previous positions: Assistant professor of the practice (2012– 2023), simulation coordinator (2020–2023), and undergraduate nursing co-director (2016–2019), Russell Sage College; staff RN, Albany Medical Center (2022–2023); RN (2003–2016) and clinical coordinator (2012–2021), St. Peter’s Health Partners Teaching: Direct Entry Adult Health Nursing Theory* Favorite pastimes: Beach time, cooking, reading, family time

“My research focuses on developing clinical reasoning skills in the classroom using active learning strategies, where we give nursing students resources to solve problems on their own. I’m also passionate about helping educators enhance their teaching.”

Shelley White Associate Professor of the Practice, Director of Experiential Learning in Global Public Health and the Common Good Focus: Sociologist and public health scholar Education: Ph.D. ’11, sociology, Boston College; M.P.H., international public health, and B.S., occupational therapy, Boston University; M.F.A., Goddard College (expected 2024) Previous positions: Associate professor of public health and sociology and director, M.P.H. in Health Equity Program, Simmons University (2016–2023); lecturer, Simmons (2009–2013); assistant professor of health sciences, Worcester State University (2013–2015) Teaching: Global Health: Theory to Practice; Public Health in a Global Society*; Senior Capstone Experience (yearlong) Favorite pastimes: Making art, spending time with nieces and nephews

“My research, teaching, and practice focus on socio-structural determinants of health, such as colonialism, racism, trade policy, and militarism, and on enacting health equity and human rights. I’m excited to host BC students for place-based learning in locations like the U.S.-Mexico border.”

boston college william f. connell school of nursing

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publications & presentations Summaries of notable articles and talks

By John Shakespear PUBLICATIONS

A Developmental Perspective on Hypogonadism and Reproduction A recent invited commentary by Associate Professor Andrew A. Dwyer, published in The Journal of Clinical Endocrinology and Metabolism, provides new insight into a study that reveals differences in reproductive potential among men with two different kinds of hypogonadism, a condition in which the body produces little or no testosterone. The original study, conducted by a team of French investigators, indicates that men who are born with congenital hypogonadism are less likely to develop fertility with gonadotropin hormone therapy compared to men with acquired hypogonadism, who have better outcomes to fertility-inducing treatment. Dwyer’s commentary notes that this study sheds light on hormonal dynamics during late gestation and the neonatal period—the so-called “minipuberty”—that play a part in determining reproductive capacity later in life. He writes that the fact that men with acquired hypogonadism do not have these dynamics disrupted so early may help us understand why they respond better to current fertility-inducing treatments and develop more tailored treatments for those with congenital hypogonadism.

Nurses’ Ethical Obligations to Unvaccinated Individuals Although the most recent CDC data reports that 69.5% of Americans have received at least two doses of the COVID-19 vaccine, many COVID patients who are admitted to hospitals remain unvaccinated. In an article published in AACN Advanced Critical Care, Associate Professor of the Practice Aimee Milliken and Assistant Professor Melissa Uveges unpack the ethical obligations nurses have when caring for individuals who have not yet gotten vaccinated. Faced with overburdened ICUs and burnout, some nurses may naturally have feelings of anger or frustration with unvaccinated patients that can impact the quality of care these patients receive. Although such feelings are completely understandable, Milliken and Uveges write, nurses are bound by the

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ethics of their profession to treat these patients with respect, consider their preferences, and try to understand the factors that influence vaccination decisions for this highly diverse group. In many cases, they note, vaccine hesitancy can be a result of misinformation or misperceptions that nurses can help address.

Identifying Predictors of FertilityAwareness-Based Method Use Some women who are contemplating pregnancy or trying actively to conceive use fertility-awareness-based methods such as menstrual cycle tracking, ovulation prediction kits, and cervical mucus monitoring. A new study by a multidisciplinary team including Connell School researchers—Assistant Professor of the Practice Melissa Pérez Capotosto, Barry Family/Goldman Sachs Endowed Chair in Nursing Christopher S. Lee, and Associate Professor Corrine Y. Jurgens—aims to identify factors that predict whether women will elect to use these methods, and which ones they will use. In a study that drew on responses from 23,418 women, the researchers found that respondents who were actively trying to conceive tended to use more fertility-awareness-based methods the longer they had been trying—women who had been trying for 6–12 months used 45% more approaches than women who had been trying for two months or less. Meanwhile, those contemplating pregnancy were more likely to try monitoring their fertility if they were married or partnered, and women who had already had two or more pregnancies used fewer methods than those attempting to conceive for the first time. The full results of the study were published this fall in the journal Nursing Research.

Full list of faculty output

Presentations

Expanding Nutrition Education in Nursing Schools One of the five pillars of the White House’s National Strategy on Hunger, Nutrition, and Health, released in September 2022, is the goal of “integrating nutrition and health.” In June, Assistant Professor of the Practice Ashley Longacre spoke on a panel addressing this pillar during a Food Tank summit at Tufts University’s Friedman School of Nutrition Science and Policy. The panel, “Expanding Nutrition Education for Healthcare Providers,” featured experts from the Tufts University School of Medicine, the Gables Institute of Nutrition and Lifestyle Education, and Food Policy Insights. Longacre, an epidemiologist, highlighted the immense potential of patient nutrition as a method of preventive care and the role that nursing can play as the largest health care profession. Nurses often spend more time with patients than physicians, she noted, so they are ideally poised to offer informed nutrition advice and identify issues such as food insecurity. Although there is growing demand for nutrition education among nursing students and an increasing emphasis across nursing school curricula, Longacre said, more data is needed to understand which approaches to nutrition education for nurses are most effective.

Exploring Couples’ Perceptions of Health and Family Decision-Making At the Gerontological Society of America’s Annual Scientific Meeting, Professor Karen S. Lyons and three coauthors gave a poster presentation of their research on how middle-aged and older couples make decisions about their families and their health.

Drawing on Health and Retirement Study data on 2,761 couples, Lyons and her collaborators employed a dyadic approach to assess whether wives and husbands in those couples had the same perception of how these decisions were made—and which partner had the final say in making them. Their findings revealed that only 69.7% of the couples agreed about who makes family decisions

and fills out medical forms, and that having the same understanding was significantly associated with greater marital support and longer marriages. Although self-reported health outcomes varied by age group and gender, these findings suggest that having an aligned understanding of how decisions are made may shape long-term health benefits just as much as whether or not those decisions are made collaboratively or individually.

Post-NICU Care for High-Risk Infants with Dysphagia Follow-up care and monitoring is important to ensure safe feeding and recovery for infants who are diagnosed with swallowing disorders like oropharyngeal dysphagia in the neonatal intensive care unit (NICU). At the annual meeting of the Dysphagia Research Society, Associate Professor Jinhee Park and two co-presenters presented findings from a longitudinal study of follow-up care practices for dysphagia. Their study compiled survey responses from the parents of 44 high-risk infants who had been discharged from a level III NICU, revealing that 55% of the infants saw at least one provider for feeding follow-up in the first two months after discharge. While 40.5% of infants saw a speech pathologist and 45.8% received follow-up care from multiple providers, less than half had follow-up swallow testing done within those first two months. This descriptive study, Park said, will hopefully provide a starting point for larger-scale studies that look at practice patterns across the United States, the influence of demographic factors and parent knowledge, and long-term outcomes for children receiving different kinds of follow-up care for swallowing issues.

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Looking for more?

Read about nurse ethicist Aimee Milliken, a Connell School associate professor of the practice, and her quest to develop systemic approaches that help nurses process feelings of moral distress and encourage them to lend their voices to ethical discussions.