An Incubator for Ideas

AN INCUBATOR FOR IDEAS By Pam Auchmutey

IN THE INNOVATION HUB, THERE ARE NO LIMITS TO IMAGINING WAYS TO IMPROVE PATIENT CARE

Margaret’s life isn’t easy. Now 72, the widow has lung, kidney, and heart problems related to diabetes. In recent months, she’s been admitted to the hospital five times. After she’s discharged, she resumes life as best she can, aided by her pregnant daughter, until her health worsens once again.

A small group of Emory nursing students have come to know Margaret. They’ve seen her in the doctor’s office, at the hospital, at home, and in her neighborhood — all without leaving the classroom. They entered her world after donning a virtual reality (VR) headset to test a program developed by Emory nursing professor Beth Ann Swan, PhD, RN, FAAN, and her team.

Swan devised the VR program to teach students about hotspotting. The health practice approach targets “super utilizers”— frequent users of health care services like Margaret — to reduce the disproportionately high cost of their care by addressing their complex medical and social needs.

Students brainstorm ideas in the Innovation Hub.

[The Innovation Hub] will serve as an incubator space...

How that takes shape might depend on the day and how they end up using that space.

BETH ANN SWAN, PHD, RN, FAAN

To develop the program, Swan collected data on Emory Healthcare patients through Project NeLL, an electronic learning library that provides nursing faculty, researchers, students, and nurses at Emory and other U.S. locations with access to vast stores of patient data. Swan sorted through the data to create Margaret and four other diverse virtual patients.

The project is one of many that faculty believe will come to life in the Innovation Hub at the Emory Nursing Learning Center. Located at the top of the staircase on the second floor, the hub is a place “where ideas will collide,” says Swan, executive director of the ENLC. “It will serve as an incubator space where students will learn to think outside the box. How that takes shape might depend on the day and how they end up using that space.”

The rectangular-shaped hub has glass walls, white boards, and movable furniture designed to ebb and flow with the ideas that take shape there. Students of all levels, from BSN to PhD, will use the space to collaborate with School of Nursing faculty and scientists, Emory Healthcare nurses, and technology and industry experts to design and test a host of ideas. Among them: phone apps, patient care devices and sensors, artificial intelligence (AI) and machine learning programs, and nursing workflow systems.

Their ideas will align with the nursing school’s Innovation Strategic Initiative. Led by Swan, the initiative provides a framework for projects in digital health technology, care delivery, simulation, design thinking, and computational health sciences.

EDUCATING INNOVATIVE NURSES

More and more, the school’s highly ranked research and education programs are attracting students who want to be innovative nurses. Colette Masunaga, a Master of Nursing student who grew up on the island of Hawaii, is one of them. After working in administration and health policy at a hospital in Honolulu, she decided to enroll in nursing school to work directly with patients. The Nell Hodgson Woodruff School of Nursing was her top choice.

“I decided to go to Emory because I knew I would get a strong clinical foundation in nursing, and that’s what I was looking for,” says Masunaga.

She is well on her way. This past summer, she completed a pediatric and maternity rotation at Emory Decatur Hospital, which proved both eyeopening and fulfilling.

“I felt so connected to expectant and new mothers and their babies,” she says. “Where I come from, we have very low access to health care. When my mom was planning to have me, the plan wasn’t about which hospital to go to. The plan was how to get to another island with acute care services in case something went wrong. Being in a health system like Emory’s, which has so many resources and so much innovation and research going on, is just amazing.”

Masunaga has been exploring her innovative side as part of a research team led by biomedical engineer Xiao Hu, PhD, associate director of the school’s Center for Data Science.

More than 10 years ago, as a faculty member at UCLA Neurosurgery, Hu developed an algorithm to help prevent nurse alarm fatigue. Typically, ICU monitors emit a host of alarm sounds, many of them false or non-life-threatening. His solution was to create a super alarm, a learning software that captures trending patterns, filters out false alarms, and more critically identifies clusters of alarms that co-occur consistently as harbingers of impending patient events. When a super alarm sounds, it indicates when a patient truly needs attention, such as when the heart or lungs begin to malfunction.

Hu has refined the algorithm to perform more effectively: It works by combining data from a bedside monitor and an electronic health record to look for patterns in a patient’s condition and treatment over time.

How does it work? Consider a male hospital patient who is experiencing cardiac arrhythmia. Meanwhile, two hours earlier, his electrolytes showed a minor imbalance.

NEW IDEAS IN RESEARCH AND TEACHING

EMORY NURSING FACULTY ARE ADEPT AT DEVELOPING NEW WAYS TO HELP PATIENTS AND TEACH STUDENTS. HERE ARE SOME EXAMPLES.

Nadine Matthie and EaseVRx

Managing Sickle Cell Pain

When adults with sickle cell disease are admitted to the hospital because of an acute pain episode, what health care providers see is only the tip of the iceberg, says School of Nursing assistant professor Nadine Matthie, PhD, RN, CNL. What health care providers don’t see is the chronic pain that these patients often experience at home.

Matthie is using a grant from the National Institute of Nursing Research to determine if a therapeutic virtual reality (VR) pain management program, EaseVRx, can help sickle cell patients manage their chronic pain in the home setting.

“Studies have been done using VR to manage chronic pain among individuals with

“The algorithm can put the two factors together,” Hu explains. “The patient’s heart is not beating well because of an electrolyte imbalance. This information gives clinicians a more precise picture of cardiac arrhythmia to explain why it’s abnormal.”

In another instance, a patient’s heartbeat interval is longer than on the previous day. The electronic health record shows the patient is on an anti-arrhythmia drug that elongates the heartbeat interval.

“The challenge is the information is there, but in two or even more different systems,” Hu says. “It takes time and attention to pull the information together. That’s where machine learning comes in. It can put existing data together to determine where the patterns matter.”

Masunaga is interested in learning how biomedical engineers and computer scientists work together to build algorithms like the one Hu has developed. In particular, she will look at how to improve nurses’ charting process so the data they enter will help the algorithm learn better.

“Nurses spend the most time with the patient,” says Masunaga. “They’re the ones who document any changes in a patient’s status.”

Going forward, the Emory Nursing Learning Center will enable Hu to test the algorithm and other projects in a simulated hospital setting. In the Innovation Hub, he can gather clinicians and industry experts together to solicit their feedback on current and future projects.

“The learning center,” he says, “will allow us to mature our algorithm so it can gather information to let nurses know when and how to intervene quickly to help their patients.”

Reflection 1: What is Harm Reduction?

"Harm reduction is important for a myriad of reasons. Most importantly, people who participate in high-risk activities like drug use and sex work are still people who are worthy of being safer and cared for. Harm reduction also has measurable benefits. Harm reduction has huge financial benefits. Millions of dollars can be saved by prioritizing prevention (National Harm Reduction Coalition, 2020). Harm reduction improves public health by preventing infection and disease and preventing unsafe disposal of drug paraphernalia. Access to Naloxone, safer

injection sites, and legislation that protects people who use drugs during an overdose

prevent overdoses and deaths (National Harm Reduction Coalition, 2020)". -Bethany Sauve

"Harm reduction is always adapting and changing according to individual and community needs. It can vary from smoking cessation and providing condoms, contraception and STI testing for safer sex practices to syringe/syringe exchange, Narcan® (Naloxone) administration and education, or PrEP/PEP (pre-exposure prophylaxis and post-exposure prophylaxis) for HIV/AIDS. Harm reduction resources like Atlanta Harm Reduction Coalition advocate for the entire community by allowing people to make the lifestyle choices they want without cutting off their connection to healthcare resources." -Kaylee Morrow 10

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fibromyalgia and back pain,” says Matthie, whose study targets Black adults, ages 18 to 50. “Why couldn’t sickle cell disease patients use it at home as part of their daily practice to control their pain? I first need to see what that would look like in this population because it hasn’t been tested among adults with sickle cell for home use before.”

In her study, Matthie will randomize individuals into one of two groups. One group will use EaseVRx, and the other group will hear the audio-only version of the pain management program via an audio stream.

Matthie’s study will continue through the end of 2023. If it proves successful, she would like to expand the idea, possibly in partnership with the Georgia Institute of Technology, through the Innovation Hub in the Emory Nursing Learning Center.

Sarah Febres-Cordero

iPads, iPhones, and Public Health

Sarah Febres-Cordero, a postdoctoral fellow in the School of Nursing, will never forget the summer of 2021.

It was a challenging time, as witnessed by students in her public health practicum. COVID-19 cases had surged once more. And summer began with a rash of overdose deaths — five in one week — in the Atlanta community.

Febres-Cordero, 17N, 20MS, 21PhD, RN, wanted students to document what they learned in a meaningful way. Instead of writing papers, she had them capture their experiences with the Atlanta Harm Reduction Coalition on their iPads and iPhones. The coalition works to reduce the impact of substance use, HIV/AIDS, and other conditions in marginalized communities.

From the EPUB “A Summer of Innovative Public Health Nursing at the Atlanta Harm Reduction Coalition,” a reflection document made by nursing students in 2021.

Students told their stories through photos, reflective writing, videos, and podcasts. They used them to create an electronic publication (EPUB), A Summer of Innovative Public Health Nursing at the Atlanta Harm Reduction Coalition.

Their EPUB was a product of the Graduate Student Nursing Academy’s Digital Innovators Program, sponsored by the American Association of Colleges of Nursing. FebresCordero was among the first nurses selected for the Digital Innovators Program, whose participants work with executives and digital innovation experts from Apple.

“Students don’t always see the value of public health nursing in the curriculum because they’re preparing to work in a hospital,” says FebresCordero. “I wanted to find an interesting way to engage them. It was meaningful to see students create something memorable and inspire them to consider working in public health.”

There’s No Place Like Home

The Emory Nursing Learning Center affords faculty and students with something they’ve never had before: a lab for learning how to care for patients in their homes.

The home lab, resembling a two-room apartment, was made possible by a gift from CenterWell Home Health, part of Humana, Inc.

Learning to care for patients in the home, nursing experts believe, provides a deeper understanding of how various factors — loneliness, access to nutritious food, mental health, and other social determinants of health — can impact their lives. The CenterWell Home Health Lab will expose students to the complexities of home health nursing.

“With this lab, students will receive valuable experience to prepare them for practice and perhaps inspire them to start a career in home health,” says Kathy Driscoll, vice president and chief nursing officer at Humana.

Located on the learning center’s second level, the home lab has a combined living room, dining room, and kitchen, and a bedroom and bath. Each room has an observation room for faculty.

Students will work with manikins and standardized patients in the apartment while instructors and classmates observe from a debriefing room next door. A telehealth and simulation office, located nearby, will allow students to engage in simulated remote consults — a part of home health nursing that proved critically important during the COVID-19 pandemic.

During telehealth scenarios, prelicensure students in the apartment will consult with postlicensure students and faculty in the telehealth office. Students can also use telehealth technology to provide simulated remote patient monitoring such as blood pressure, blood glucose, and heart rate.

The CenterWell Home Health Lab, the largest of its kind in Georgia, will expose students to a variety of possible scenarios: an elderly man transitioning home following a heart attack, a young girl with asthma, a teenage boy with autism, a new mother who delivered her baby by C-section and is learning to breastfeed, a 30-something man on home chemotherapy, and a 50-something woman receiving end-of-life care.

“Home health care is not just about patients who transition from acute care in the hospital,” says assistant clinical professor Quyen Phan, DNP, APRN, FNP-BC, who provided feedback in the design of the home lab. “It’s about patients who receive ongoing care.”

“The home lab will help our students think about nursing practice outside the four walls of a hospital,” Phan adds. “It will provide them with the skills, knowledge, and competencies they need when they aren’t in total control in the hospital. They will learn how to deliver care in the home, where patients spend most of their lives.” As nursing faculty and alumni will tell you, students can never have too much classroom, study, and chill-out space. The second floor of the Emory Nursing Learning Center is designed to meet those needs.

Around the corner from the Innovation Hub are three flexible classroom spaces, all equipped with interactive technology to create an active learning environment for students. Two smaller classrooms seat 45 students each. A large classroom seats up to 150 students, but not in typical theater style. Instead, students are grouped at large tables within easy view of large portable display monitors.

“We designed this classroom for peer-to-peer learning,” says Tricia Benson, 86MN, who helped guide how learning center spaces would be used. “Students will learn from each other as they work on projects and select the best ones to share with the class. The classroom setup will ensure students know how to work collaboratively as part of a clinical team when they begin to practice as nurses.”

Often, before and after classes, students can use the open skills lab to learn and practice on their own. The lab has hospital beds, tables, chairs, and adult, child, and infant manikins. It is named for the late Charles F. and Peggy Evans, whose bequest in 2003 made clinical skills and simulation learning possible at the 1520 Clifton Road building.

THE LEARNING CENTER OFFERS AMPLE ROOM FOR CLASSROOM LEARNING, STUDY TIME, SKILLS PRACTICE, AND DOWN TIME

SPACE JUST FOR STUDENTS

The second floor features a variety of other spaces just for students: a lounge, a wellness and meditation room, a room for nursing mothers, and a study area and outdoor balcony. It also includes a home lab with data collection capability resembling a small apartment, a telehealth office, conference rooms, and touchdown space for faculty, appointed with original wood paneling.

PAYING IT FORWARD

Emory nursing alumni are bound by the rewards and challenges they experienced in nursing school. Several spaces on the second floor are named for alumni whose gifts are intended to make the path easier for current and future nursing students.

Donté Flanagan, 04OX, 06N, 10MSN, DNP, is a certified registered nurse anesthetist who lives with his family in Philadelphia, Pennsylvania. He still recalls how daunting nursing school can be, especially for students who are underrepresented because of race, ethnicity, or gender. He and his wife, Ashlee, made a gift to name the student lounge in that spirit. They see the Flanagan Solidarity Lounge “as a place for students, especially those with marginalized identities, to feel safe and inspired to learn, achieve, and excel,” says Donté.

“Sometimes, going from the classroom to various clinical settings can be an unexpected and overwhelming experience as a novice,” he adds. “The Emory Nursing Learning Center will help alleviate some of those early missteps while preparing nurses who can step into their new roles and have immediate impact.”

Mary McCabe, 72N, MA, devoted her career to improving survivorship for patients at Memorial Sloan Kettering Cancer Center in Manhattan. As an undergraduate nursing student at Emory, she found it difficult at times to find a quiet, relaxing place to study. In that spirit, she made a gift to name the Mary and Thomas McCabe Student Study Area and Balcony.

“It seems ideal to me to have an informal place for students to spend time in solitary study or collaborative learning,” says McCabe. “Having such space is a treasure, and it makes me want to grab my laptop and find a seat!”

Tucked between the study area and a student locker room is a new mothers room named for Rose Cannon, 74MN, 95PhD. Her gift stems from her 37-year career in maternal and newborn practice and education at Emory’s nursing school.

Nancy Langston, 72N, PhD, FAAN, ANEF, retired dean of the Virginia Commonwealth School of Nursing, knows what it’s like to open a new building. She oversaw planning and construction of a four-level building, which had plenty of open spaces for nursing students. After the building opened, she learned that some students preferred quiet, closed spaces for studying, often in an unoccupied classroom.

Toward that end, she designated a gift for the Langston–McCain Conference Room on the second floor of the new learning center. “Given the opportunity to support a space that I knew from past experience would be put to good use by individuals and small groups of students, I was sold on the idea,” says Langston.

The large classroom features high-tech monitors and group seating to foster collaborative learning.