SPRING 201 8
How psychiatric mental health NPs offer heart and hope during our nationâ€™s mental health crisis
2.16.18 / Perennials for Patients volunteers transplant their first seedlings into one of three new hoop houses purchased with funds from the School of Nursing Class of 1966 Endowment. The project—started by Reanna Panagides (BSN ’20)—brings small vases of cut Shasta daisies, sedum, and Russian sage to patients at UVA Medical Center in need of cheer. There’s hard science behind their cultivation, too: One study found 90 post-surgical patients recovering in rooms with greenery required less pain medication, had lower blood pressure, and felt less anxious and fatigued, while another study suggested that the sight of indoor plants enhances creativity and mood. “We’re spreading love through flowers,” says Panagides, left, of Sterling, Va., pictured here with Kathryn Rhyne (BSN ’20). Photo: Coe Sweet
SPRING 2018 6 Heroes’ Narrative 8 A PATH FORWARD 18 On My Bookshelf 22 Taking Prevention on the Road 28 Class News & Notes 30 Getting Political 32 Air hugging an angel
FROM THE DE AN
“Mental health begins in the feet.”
ne of my favorite quotes from Angela Barron McBride, dean emerita and a distinguished professor of nursing from Indiana University, acknowledges a basic truth that actually could have very little to do with shoes: How we feel in our bodies affects our minds (and vice versa). Today, as millions suffer from serious mental illnesses—now the leading cause of disability around the globe—clinicians of all stripes have an opportunity to improve people’s quality of life and well-being by helping them understand, cope, and explore treatment options, pharmaceutical and otherwise. But the psych work inherent in nursing often goes unnoticed and unheralded. As a trauma and critical care nurse for decades, I know well the emotional pain that accompanies physical injuries, as well as the mental consequences physical pain can exert. Though it was the 1980s when I last worked in Baltimore’s Shock Trauma unit, much, like the feverish scramble to save a life, is fresh. Other memories— like the poignant recollection of sitting with the devastated parents of a teenager we couldn’t save, or my colleagues’ sensitive care for a young woman disfigured by her injuries—are quieter, but equally INS ME L O D Y R O BB powerful in their recall. And with mental health at the core of so many of society’s ills, it is a good time to celebrate the day-to-day triumphs of the nurses who make psychiatric mental health their primary focus. Their care leads to dramatic improvements in the quality of life and the gentle joy experienced by their patients and families. Like our featured psych student, Cindy Shively (MSN ’12, PM, ’19), they are key collaborators, and truly the lynchpin for wellness. It’s why the recent tripling of applicants to UVA’s advanced practice mental health nursing programs is so heartening. But in reality, each of us must embrace the mental health nurse inside. The less we think of mental health nursing as a separate entity, as a specialty that only some clinicians do, the better off our patients will be. Compassion, after all, really starts with listening. What would our world be like if we all were better listeners?
Dorrie Fontaine, RN, PhD, FAAN Sadie Heath Cabaniss Professor of Nursing and Dean
SADIE HEATH CABANISS PROFESSOR & DEAN Dorrie K. Fontaine, RN, PhD, FAAN EDITOR Christine Phelan Kueter CONTRIBUTORS Louisa Baker Andrea Ceniceros Jessica Eustace Caroline Hirst Christine Kennedy, RN, PhD, FAAN Kelly Williams McCaskill PHOTOGRAPHY Robert Merhaut Christine Phelan Kueter Melody Robbins Coe Sweet DESIGN Communication Design Inc. ALUMNI COUNCIL COMMUNICATIONS COORDINATOR Matt Lemieux (CNL ’11, PNP ’15) UNIVERSITY OF VIRGINIA SCHOOL OF NURSING Established in 1901 Virginia Nursing Legacy is published twice a year by the UVA School of Nursing and the Nursing Alumni Association with private funds. Read online: MAGAZINE.NURSING .VIRGINIA.EDU
t’s tempting, says Julie Haizlip, director of the Center for Appreciative Practice (CAP) and a professor of nursing, for change-makers to focus on all that’s wrong with the people, processes, or systems they’re seeking to alter. But it’s CAP’s contention that there’s far greater potential to motivate culture shifts by starting out positively. Whether a personal interaction, a consulting engagement, scholarly writing, or a large scale summit, their premise is that there is much to learn by understanding first what’s going well. It’s precisely why CAP faculty begin their work with a deceptively simple question that goes to the heart of their ethos: What do things look like when they’re at their best? “In healthcare, we’re trained to look at what’s wrong, so it’s easy to lose track of what’s right,” explains Haizlip who, with nursing faculty Anita Thompson-Heisterman and Susanna Williams, and medical colleagues Peggy Plews-Ogan, John Schorling, and Natalie May, recently marked CAP’s 10th anniversary with a move to the School of Nursing. “And
IN BRIEF being that humans are wired to be more attentive to the negative, rather than positive aspects of their environment, it’s not surprising that it affects how people learn, how they process information, and what they remember. It requires deliberate attention to begin with, and focus on the positive.” In both nursing and medicine, worst-case scenarios often drive learning. And while it’s critical to be vigilant in considering all that could go wrong, this hyper-focus on catastrophe can deepen and centralize pessimism, which, in turn, infects personal and professional relationships. And years of training are difficult to simply turn off. As they lead improvement seminars in academic, clinical, and business environments, CAP faculty create “improbable pairs”—so the CEO sits with a student, or the nurse manager partners with the house-keeper, Plews-Ogan explains—to allow each participant to reflect on what can be learned when things go well, while taking in another’s perspective. When confronted with a complaint, CAP faculty ask people to articulate what they’d like to see instead. Envisioning a positive goal, after all, is far easier to approach. “People buy into the change they help create,” says Haizlip. +
2017 11.4 Hundreds of nursing students received white coats, pins, and praise at the School’s annual Undergraduate Awards, Recognition and White Coat Ceremony event during Family Weekend. 1 11.8 One of three national sites funded to teach interprofessional education, UVA’s Center for ASPIRE hosts its largest cohort ever for the three-day Train-the-Trainer Faculty Development Program. 11.10 Dozens gather to honor Mavis Ford Claytor (MSN ’85, BSN ’70), the School’s first African-American graduate, at her portrait unveiling, a permanent testament to Claytor’s determination and trailblazing career in nursing. 2 12.4 Men Advancing Nursing—the MAN Club, for short—published its first calendar picturing more than a dozen UVA male nursing students and alumni and canines from around Grounds. 3 12.6 PhD student Trina Kumodzi was selected as a College of Arts & Sciences 2017 Power, Violence and Inequality Collective Fellow, a group of scholars at UVA studying violence rooted in power and inequality. 12.7 The UVA group Student Nurses Association of Virginia raised more than $700 teaching CPR to purchase toys for UVA Children’s Hospital’s “North Pole Shop.” 3
2018 LGBTQ+ Health Care Symposium:
Embracing Inclusion & Diversity in Caring for the Whole Person.
May 10, 2018
7:00 - 5:00 Boar's Head Inn, Charlottesville, VA
12.18 Professor Pamela Kulbok—among the keynote speakers at the 7th annual International Hong Kong Nursing Forum— was lauded by Sophia Chan, former head of the Hong Kong University School of Nursing and Hong Kong’s current Secretary for Food and Health.
Provided by the Office of Continuing Medical Education, University of Virginia School of Medicine and the School of Nursing Continuing Education
2018 1.8 UVA Nursing’s “Green Team” earned a silver award as a Certified Green Workplace from UVA Sustainability for its efforts to improve practices, one of just 10 entities around Grounds to earn the distinction. 1.22 Richard Westphal, chair of the Department of Family, Community and Mental Health Systems, was named the Woodard Clinical Scholar Professor of Nursing, while Lili Powell, a Darden and nursing professor, was named the Maria & John Kluge Professor in Compassionate Care. 4 2.13 Virginia Nursing Legacy received a “special merit” award in the category of magazines from the Council for Advancement and Support of Education’s District III. 2.2 With support from Del. Roxann Roberts (R-Chesterfield), DNP students HoChong Gilles and Cindy Fagan (both DNP ’18)—leaders of the Virginia Council for Nurse Practitioners—championed
House Bill #793, which eases practice restrictions for NPs in the Commonwealth. The bill was approved both by the House and the Senate, and awaits Gov. Ralph Northam’s signature in early April. 5 3.13 From investigations of asylum hospitals’ architecture to antibiotic exposures in pregnancy and the link to obesity, the annual Barbara J. Parker Research Symposium celebrated the scholarship of more than a dozen graduate nursing students at a day-long event punctuated by nurse historian Arlene Keeling’s presentation on the nurses of Ellis Island. 3.20 Again in the 2019 issue, the School received a top ranking in U.S. News & World Report’s annual guide to Best
Graduate Schools. Virginia’s only nursing school in the nation’s top 20, the School tied for no. 9 among public institutions, and ranks no. 7 among public institutions with Doctor of Nursing Practice programs. Among a highly competitive field, the Clinical Nurse Leader program is no. 3 and the Psychiatric Mental Health Nurse Practitioner program no. 11. 5.10 More than 100 attendees gathered for the School’s first-ever LGBTQ+ Health Care Summit, organized by Continuing Nursing Education, which offered everything from Safe Space training to guidance for clinicians on how to better connect with and care for LGBTQ patients. 6 +
A Quintet of Retirements
ew faces are more recognizable than those of professors Rebecca Harmon, Catherine Kane, and Pamela Kulbok, who taught mental and public health nursing courses to countless nursing students since the early 1990s. This spring, the trio—who collectively served the school for three-quarters of a century—retires. Equally notable are last fall’s retirements of Arlene Keeling, Bjoring History Center director and professor, and Kathy Haugh, a long-time instructor and the former director of the Clinical Simulation Learning Center. We wish them well! + 4
What They Said “As humans, we’re wired to follow routines, to repeat the same behaviors over and over. I think about how we routinely ask our patients, ‘What is the matter with you?’ “Now consider the power of changing just one thing— the order of those words— to, ‘What matters to you?’” Clareen Wiencek (2017, November). A New Vital Sign [Editorial]. AACN’s Bold Voices, 8(11), 22.
“Research shows that compassion changes the brain, lighting up neural pathways associated with good feelings, joy, and love. People who are repeatedly compassionate actually strengthen these compassion-related brain regions, and report higher satisfaction in life and happiness … [and while]
compassion comes from heroes, far more frequently it comes from regular people like us who do one small, kind thing to make someone else smile.” Tim Cunningham (2017, December 17). Compassion in the Crevices: A Nurse’s Story [Editorial]. Richmond Times Dispatch
“Kids with life-limiting illnesses who receive hospice care die less traumatic deaths. Their symptoms—acute pain, shortness of breath, diarrhea, unsettling body secretions, and mental fogginess—ease when managed by a hospice provider. And they’re home, with siblings, parents, pets, on familiar turf, lying on clean sheets in their very own beds. “Lean systems can be good. And waste in health care is real. But before you nod your head to an ACA repeal, or cheer for small government, remember … that a society is judged on how it cares for its weakest, most vulnerable citizens.” Jessica Keim-Malpass and Lisa Lindley (2017, April 23). Obamacare repeal hurts kids who need hospice [Editorial]. Richmond Times Dispatch
“No longer can the gruff, if brilliant, surgeon be excused for rudeness. No longer does the snide veteran nurse get a pass. As new clinicians, you’re schooled to understand that bedside manner and assessment skills are just as important as your ability to be a good colleague to your peers … So graduates, be driven, be passionate, but be well. Don’t be afraid to expect a lot from yourself. But remember this, too: Expect at least as much from your employer.” Rebecca Harmon and Dorrie Fontaine (2017, May 21). Take care, graduates [Editorial]. Richmond Times Dispatch
STUDENT IN FOC US
HEROES’ NARRATIVE Franklin Hickey (PhD ’18) BY LOUISA BAKER
hen planes struck the Twin Towers on 9/11, Franklin Hickey was a mere 20 miles away, at work as the administrative director for Patient Care Services at Union Hospital in Union, NJ. “The day started like any other,” recalls Hickey. “I was making rounds throughout the hospital and noticed people crowding around televisions with perplexed looks on their faces. From there, things quickly changed.” He recalls the “emotional chaos” of that day, which shook him personally and professionally, and the turbulence that soon followed. “My role continually evolved,” says Hickey. “That day, I was a nurse, hospital administrator, incident commander, security officer, social worker, and crisis worker, just to name a few.” In anticipation of the walking wounded making their way to New Jersey, Hickey and his nursing team set up triage tents in the hospital parking lot, lining the driveway with rows of stretchers. Although the hospital mobilized quickly to provide care and services, few patients came—a heartbreak that Hickey reflects was the hardest part of the day: being prepared, but without many survivors to help. Most poignant amid the grief and tragedy, Hickey vividly remembers how his fellow nurses— some of whom lost family members in the terrorist attacks—selflessly placed the care of others before their own personal needs. Thirteen years later, when Hickey was offered the position of 6
ambulatory manager with UVA Health System with an opportunity to pursue a PhD in nursing— a position he happily accepted—it was his unforgettable experiences from Sept. 11 that would ultimately push his scholarship in a new and unexpected direction: narrative nursing history. The shift even surprised Hickey. “When I first started my PhD, I’d planned to do a quantitative study evaluating quality among healthcare systems,” he explains. “It wasn’t until I took a nursing history course with Professor Arlene Keeling that I considered focusing my dissertation on nursing history. She helped me realize that my perspective and experience of 9/11 was fodder for scholarship, and that’s fueled my interest in telling the oral histories of nurses working in the New York City tristate area that day.” His scholarly pivot also fortified Hickey’s connection with faculty members like Keeling and History Center Director Barbra Mann Wall, his advisor, whom he calls “guiding lights.” “My favorite aspect of attending the School has been the support, guidance, and collaboration of all faculty and staff,” says Hickey. “I tell my friends that while it’s a rigorous program, the faculty members have made it enjoyable.” Post-graduation, Hickey aims to merge his two decades of hospital administration experience with his academic pursuits to bridge the gap between nursing research and practice. He plans to continue building on his interest in nursing history by sharing the stories of unsung nursing heroes—specifically, those impacted by manmade and natural disasters. +
“She helped me realize that my perspective and experience of 9/11 was fodder for scholarship.”
How psychiatric mental health NPs offer heart and hope during our nation’s mental health crisis
Ray* was sure he was having a heart attack. STORY AND PHOTOS BY CHRISTINE PHEL AN KUE TER
* Last name withheld to protect patient identity
As usual, he’d headed on foot to walk the few miles to his job at the Dollar General, bundling up in a hoodie to stave off late winter chill. Sipping an energy drink between puffs on a cigarette, by the time he arrived at work, he “felt like [he’d] done a big old bag of cocaine,” he told nurse practitioner Cindy Shively (MSN ’12, PM ’19), noting the visible vibration of his coat hood beating to the thump of his fluttering heart. For the middle-aged Memphis, Tenn., native, the racing pulse was terrifying. Even a day after being whisked by ambulance to the ER, where doctors couldn’t find any evidence of heart trouble, Ray still felt rattled. So he headed to see Shively, the only full-time clinician at the Free Clinic of Franklin County in Rocky Mount, Va., who listened intently to his story while orbiting around him, checking ears, pulse, and nostrils, Ray yes ma’aming, and no ma’aming each of her questions. Physically, all seemed normal. Circling a stethoscope about her neck, Shively leaned in and gently prodded Ray about his caffeine intake, as well as his eating, digestive, and sleep habits. She knew he’d tried Zoloft for depression, and that he hated how it blunted his emotions; she knew, too, that Ray sometimes struggled to keep his temper in check—“I’m allergic to B.S.,” he’d told Shively. Her diagnosis: An anxiety attack. “Now you see me holding this coffee cup,” confided Shively, “so you know I’m not going to tell you not to have a cup or two in the morning. And back in the day, I was a smoker, too. But I’ve seen people have a full-blown anxiety attack, and know it can feel like a heart attack. Drinking some more water will help; fewer energy drinks will help, too. And let’s see what we can do to adjust your meds.” Ray caught Shively’s eyes. “I still need to find my Zen,” he said softly, twisting his wool cap in his hands. Smiling, she nodded back. 9
1in 5adults 44 million people — experiences a mental illness each year National Alliance on Mental Illness
n many ways, Shively’s job is a perfect fit for a psychiatricmental health nurse practitioner. Because billing is not based on an appointment’s length, she’s unrushed, and can ask after the particulars of patients’ habits, prod a bit into their social and economic lives, and, if she knows them— and she usually does—ask after their children, grandchildren, pets, and jobs. Here in Franklin County, population 56,000—the former home to thriving furniture, paper, and textile factories—patient stress is the rule, not the exception. About 10 percent of residents (including more than 12 percent of children under 18) live below the federal poverty line. And the stressors of being poor—in itself “a full time job,” says Donna Minnix Proctor, executive director of the Free Clinic—often exacerbate existing mental health issues, or provoke and establish them. Well over half of patients have mental illnesses for which they’re receiving medication, Shively says, as well as a complex cascade of other chronic health conditions, such as diabetes, hepatitis, alcoholic cirrhosis, fatty liver, and cardiovascular disease. Those factors—as well as the fact that the area’s community services board tasked with providing psychiatric, mental health, and crisis services often takes weeks or months to make a diagnosis—makes Shively’s job a constant challenge: precisely the reason she returned to UVA in pursuit of answers. “For me, it became more and more evident that I needed to, had to learn a lot more,” says Shively, a pattern Catherine Kane, a psychiatric mental health nursing professor at UVA since 1992, knows well. “When folks first go into nursing and medicine, they want to see results, stitch up things, work with all the shiny baubles, save lives,” says Kane. “But psych is long-term, and often kind of messy. And many discover what we know: That more than half of people seen in family practice have a diagnosable mental health problem. Facing that, they say, ‘You know, I’m not quite knowing what I’m doing here, and I have to learn more about it.’ “And that’s when they come to our program.” 10
n colonial days, people with mental illness who lacked a family caregiver were often confined to jails and almshouses where they mingled with the elderly, the blind, people with epilepsy, abandoned children, unwed mothers, and petty criminals.1 Those tending them earned the moniker “keepers,” a nod to the restrictive nature of the job. Though the Pennsylvania Quakers were the first to offer formal hospital space designated for the mentally ill in 1752— albeit in the basement, with shackles and chains for the unruly2—Virginia was the first state to set aside funds to open a small hospital for the mentally ill in Williamsburg in 1773, a place today known as Eastern State. New York City, as well as the cities of Philadelphia, and Lexington, Ky., soon followed suit, and by 1890, every state in the United States had at least one mental institution.3 But demand was fierce. By the mid-1900s, American mental institutions housed more than 500,000 patients, including Long Island’s massive Pilgrim State Hospital where, by 1954, more than 13,000 patients lived.4 By the early 1900s, “nurse” became the preferred term for individuals caring for the mentally ill, marking the “shift from viewing nurses as domestic servants toward a developing profession.”5 Though asylum staff had traditionally been hired for brawn, leading thinkers increasingly understood that caregivers could positively impact their patients. The 1885 publication of The Handbook for the Instruction of Attendants on the Insane “represented a move away from the oral tradition [of] passing on nursing skills [to] the beginning of a literature base of mental health nursing.”6 By 1902, 15,000 copies of the “little red book” had been sold, and by 1920, the first psychiatric nursing textbook—Nursing Mental Diseases, authored by Harriet Bailey—was published. Psychiatric nursing education had officially been born. Still, it took a while to take hold. Even by the 1950s, when more than half of the nation’s patients were mentally ill, nurses were “primarily taught how to care for the other half.”7
“One of the best things we can do as nurses is to listen, to give our patients our undivided attention.”
HOW IT’S BEEN TAUGHT
Bridgette Vest (DNP ’13)
With the advent of pharmaceuticals, from sedatives in the late 1800s to tranquilizers and anti-psychotics by the 1950s, many mentally ill patients were prepared for their next cultural shift: transitioning out of mental institutions and into the community. The Community Mental Health Center (CMHC) program, initiated by the federal government after President Kennedy signed the Community Mental Health Act in 1963, propelled this progress. The CMHC also hugely expanded services. Between 1955 and 1977, the total number of patient care episodes for mental health grew from 1.7 million to nearly 7 million, with CMHCs tending a third of those cases, “[shifting] the primary locus of mental health care from hospital-based, inpatient locations to community-based outpatient locations.”8 As those with mental illness began to trickle into society, on-the-ground psychiatric support staff had expanded roles. Now, managing the care of mentally ill patients—helping with medication, and nurturing socialization, emotional and work life—meant caring for family members, too. As a provider through the 1970s and 80s, Kane recalls being the navigator for parents struggling to understand why their progeny didn’t just snap out of it, why they couldn’t will themselves to change, and what a path forward might look like. Many times, Kane recalled, it wasn’t the path they’d imagined, but one, nevertheless, that offered hope.
oday, thanks to a growing ability to diagnose mental illnesses, an array of psychotropic medications, insurance companies’ expanded coverage, and a variety of government and community programs aimed at helping the mentally ill integrate into and contribute to society, psychiatric nursing is a field that’s powerfully positioned to improve the nation’s mental health. But it’s a colossal undertaking. One in five Americans—about 44 million people—has a diagnosed mental illness: addiction, anxiety, and depression each exact a sizable toll. And while the specialty of psychiatric mental health nursing accounts for only a small portion—about 4 percent—of the more than 234,000 nurse practitioners in the United States10, there’s a growing appreciation for the expansive role this special group of clinicians play as gatekeepers of physical and mental health. And thanks to technology, their help is reaching farther than ever.
s early as 1921, third-year nursing students were required to take Mental and Nervous Diseases, a 16-credit course. By 1938, the second-year course Psychiatric Nursing had doubled in scope to 30 hours, aiming to develop students’ “basic understanding of the etiology, symptomology, course, and treatment of the more common types of psychiatric disorders.” 9 Today, mental health topics are naturally interwoven into the content of many general nursing courses, like Foundations of Nursing CARE, while others are semester-long dives into the subject: Psychiatric Mental Health Nursing, Biological Basis of Mental Health Nursing, Mental Health Theories and Therapies, and Psychiatric Diagnostics and Differential Diagnoses, to name a few. Today, graduate students seeking the psychiatric mental health certification must accumulate at least 500 hours of clinical experience through rotations available at a variety of mental health sites throughout Virginia. Undergraduates complete nearly 100 hours of mental health nursing training at local community clinics, hospitals, and social services sites. While UVA’s psychiatric mental health clinical nurse specialist master’s program was established in 1972, it was largely supplanted by the psychiatric mental health nurse practitioner program established in 2001, following a push in the late 1990s from the National Organization of Nurse Practitioner Faculty. Today, UVA’s psych mental health programs are offered via a variety of routes, including a traditional master’s degree; a certification en route to a Doctor of Nursing Practice degree; or as a post-master’s certificate for individuals with other certifications, like family nurse practitioners. And while the psychiatric mental health nurse practitioner program has traditionally been among the School’s smallest, interest is building. Once again this year, applications are up sharply—89 percent over 2017 numbers—for entry in fall, 2018. “People are increasingly aware of the need for psych nurses,” says assistant professor Edie Barbero, one of four fulltime psychiatric mental health faculty members, “and feeding that is the opioid crisis, a growth in the number of insured, a growing awareness of mental health as the gateway to overall health, and the fact that many family nurse practitioners want to come back and better serve their practices.” +
TELEPSYCHIATRY “makes me even more attentive to cues, clarifying what patients are saying, and being even more observant.” Sean Sembrowich (PM ’12)
COE SWEE T
f professional experience sharpened Sean Sembrowich’s (PM ’12) knowledge of addiction—he’s a member of UVA’s Center for Leading Edge Addiction Research, where he monitors patients enrolled in trials assessing the efficacy of drugs to fight alcoholism, opioid addictions, and cocaine and methamphetamine use—technology has expanded it. In addition to working as a provider at UVA’s Elson Student Health Center, where he works with UVA students struggling with substance abuse and other mental health issues, Sembrowich also sees patients via telemedicine in locations that can be hundreds of miles away, where there are few mental health providers. Always keen-eyed and a good listener, Sembrowich, a former ER nurse and family nurse practitioner, finds himself very much at home in the work. And if he was initially skeptical of telemedicine as an approach, these days Sembrowich is sold. The usually 45-minute appointments—which involve a Skype-like secured video link and face-to-face contact across the miles with patients being treated for mental illnesses, sometimes with addiction lurking in the background—actually fine-tune his therapeutic skills, he says, making him “even more attentive to cues, clarifying what patients are saying, and being even more observant.” Other psychiatric mental health nurse practitioners define their practice by population, tending to those who are homeless, or individuals working in law enforcement, for example. Bridgette Vest’s (DNP ’13) population of choice? Veterans. Vest, who’d “always cared for people, even as a child,” first worked with veterans during a summer internship while on break from college. Across her nursing career, however, she felt particularly drawn to those suffering from substance abuse. Today, with more than 30 years’ experience at the Salem Veterans Administration Medical Center caring for veterans from Vietnam to Iraq and Afghanistan, she continues to find the work powerful and relevant. It’s also been a journey of discovery. In her early work as a nurse practitioner, Vest noted that many patients who suffered from substance use disorders frequently had mental health diagnoses. Noting the complexity of their cases, she determined that there was much more to learn about mental health, and returned to UVA to pursue a DNP, earning a post-master’s certificate as a psychiatric mental health nurse along the way. “I really felt like I needed more,” she recalled, “much, much more, so I could help them.” Rigorous training in the facets of mental health nursing “just made sense” to her work, says Vest, noting that UVA mentors Kane, Barbero, and Rebecca Harmon always taught her “the importance of being present and being a life-long learner.” Today, Vest is part of the V.A.’s team working with more than 78,000 eligible veterans living in 26 counties and 13 cities in southwestern Virginia, and serves on the Veterans Health Administration’s Tobacco Advisory Group. With a private practice and several faculty positions, Vest is also exploring
10.1years reduction in life expectancy attributable to mental disorders JAMA Psychiatry (2015), 72(4), 334-341.
new and novel ways to ease pain, manage stress, and treat addiction to drugs, alcohol, and tobacco through medication and acupuncture, among other therapies. “One of the best things we can do as nurses is to listen, to give our patients our undivided attention,” says Vest, who keeps her grandfather’s American flag in her office as a poignant reminder of her patients’ sacrifices. “Helping veterans is incredibly rewarding. With every veteran, there is a story.” 13
U.S. veterans commit suicide each day Centers for Disease Control (2017). Morbidity and Mortality Weekly Report. Altanta, GA: US Department of Health and Human Services.
“My goal as a provider isn’t to tell you what to do—you’ve been told what to do your whole life. It’s to engage in a relationship to impact you where you are.” Rosalind DeLisser (MSN ’02)
COE SWEE T
or Teresa “Sid” McColley (BSN ’96, MSN ’97), her first clinical interactions as a nurse included outreach and medication services for homeless individuals with serious mental illness who needed housing and therapy. After years of pounding the pavement throughout Charlottesville-based Region 10’s catchment area, terrain that included Charlottesville and Albemarle County, McColley was on the interdisciplinary team that established the novel Program for Assertive Community Treatment, or PACT, which targeted difficult-to-reach people with mental illness who otherwise did not engage with or respond to traditional mental health service programs. As part of PACT, McColley met with clients where they were most comfortable—at the drop-in center, a coffee shop, a park, or the public library—to provide medication, supportive counseling, cognitive-behavioral tools, and training in independent living skills. For people with mental illness, “there’s very little advocacy, and so much stigma,” says McColley, today the section manager for Sonoma County, Calif., Behavioral Health, where she oversees everything from mental health community clinics to a robust crisis intervention team training program for law enforcement. “But I find the people I’ve encountered over the years who have mental health challenges are just brilliant, and so interesting, and they just keep plugging away at this thing that our whole culture really misunderstands. There’s a real social justice aspect to it.” That same passion for social justice drives Rosalind DeLisser (MSN ’02) in the classroom, just an hour to the south of McColley. Though DeLisser’s nursing career has taken her around the world and involved a great deal of intense onthe-ground advocacy for the homeless, those suffering from substance abuse and HIV, and military veterans traumatized by injuries and combat, today, she’s sharing her experiences to inspire the next generation. And oh, the stories DeLisser can tell. It was the early 2000s when, with help from San Francisco General Hospital and the city’s Mission Mental Health Clinic, DeLisser painstakingly established a novel program integrating primary and psychiatric care under the same roof. Knowing that people with severe mental illness are often too disorganized, chaotic, and paranoid to get routine primary care, DeLisser determined to build a “clinic within a clinic” so that mental health visits might be combined with routine care, like Pap smears, or heart and blood sugar monitoring. There, she worked with individuals suffering with severe mental illness, substance use disorders, victims of domestic violence, Latino immigrants, and African-American men with severe mental illness recently released from jail. Following that experience, DeLisser was stationed in a German hospital where she cared for American soldiers traumatized by combat, and, after returning to the United States, worked with HIV-positive women in a trauma-informed primary care clinic at the University of California San Francisco (UCSF), where she now leads the clinic’s substance abuse treatment services and provides psychiatric assessments, consultation, and treatment for severe mental illness. While each segment of DeLisser’s career has been powerful and disparate, certain themes have emerged.
number of hours of clinical experience each UVA Nursing undergraduate has as part of their Psychiatric Mental Health Nursing course
MENTAL HEALTH BY THE NUMBERS
2/3 1 in 5 80%
LGBTQ+ youth are two to three times more likely to attempt suicide than straight youth 2
Percentage of America’s 234,000 advanced practice nurses who are certified in psychiatric-mental health nursing 3
Proportion of primary care providers who report difficulty in accessing psychiatric services 4
Number of U.S. children that show signs or symptoms of a mental health disorder each year. 6 Percentage of children who need mental health services but won’t get them. 7
Depression’s rank, worldwide, as the leading cause of disability 1
National rank of UVA Nursing’s psychiatric mental health graduate program (US News & World Report, 2019)
Increase in Psychiatric-Mental Health program applications in 2018, over 2017
Earnings lost due to serious mental illness in America each year 8
1. National Institutes of Mental Health, www.nimh.nih.gov 2. National Alliance for Mental Illness, www.nami.org 3. 2017 AANP National Nurse Practitioner Sample Survey 4. Cunningham, P. (2009). Beyond Parity: Primary Care Physicians’ Perspectives on Access to Mental Health, Health Affairs. 5. National Council for Behavioral Health, www.thenationalcouncil.org 6. National Alliance on Mental Illness, www.nami.org/getattachment/Learn-More/Mental-Health-by-the-Numbers/childrenmhfacts.pdf 7. Kataoka, S.H., Zhang, L., & Wells, K.B. (2002). American Journal of Psychiatry, 159(9), 1548-55 8. American Journal of Psychiatry and the U.S. Surgeon General’s Report, 1999
Number of jail bookings that involve a person with a mental illness 5
“One of the things that makes nurse practitioners unique is having a framework of nursing education based in humanism, holism, and patient-centered care,” says DeLisser from her UCSF office where she directs the psychiatric nurse practitioner program, which has more than doubled in size since her 2013 appointment. “My goal as a provider isn’t to tell you what to do—you’ve been told what to do your whole life. It’s to establish an alliance not based on power, or hierarchy, but to flatten that dynamic and really think about being a facilitator of an individual’s health and wellness. “That’s just what we do,” adds DeLisser. “We engage in a relationship to impact you where you are.”
aroline McKinnon’s (MSN ’02) patient—a 60-something woman with chronic schizophrenia—wasn’t talking. But that wasn’t for McKinnon’s lack of trying. Her task—part of her psychiatric rotation as an undergraduate back in the 1980s—seemed simple enough: Have a 15-minute conversation with the same patient each week, and record and analyze the interaction. But McKinnon’s patient had almost nothing to say. And that, laughs McKinnon— today a psychiatric nursing professor at Augusta University in Augusta, Ga.—made the then-19-year-old nascent nurse a nervous wreck. “The less she would say to me, the more anxious I became,” recalls McKinnon, who worked for years as a nurse psychotherapist at the Gilder Regional Institute for Children & Adolescents, in Rockville, Md., before transitioning to academia in 2014. “And the more anxious I got, the more mistakes I made, trying to get her to talk to me. If I had just stopped and paid attention—focused on the feelings, rather than the task I had to complete—we might’ve been in a different place. “It never occurred to me then to say to her what I’d say now: ‘It’s OK for us to sit here quietly.’ I was too focused on what was going on for me to be able to communicate.” It’s a story McKinnon now shares with her students—some of them budding mental health nurses themselves. She also shares how she responds to the question she’s been asked her entire professional life when she shares that she works with individuals living with mental illness: “Why would you ever want to do that?” “Having the opportunity to take care of people with mental health conditions is a privilege, and something to be desired,” asserts McKinnon. “For me, it’s where I should be. That’s what I tell my students all the time: No matter what they want to do in nursing, pay attention to that internal passion, that drive. “This is work you get to do,” she adds, “not something you end up doing. There’s a real difference.” +
WATCH ‘A DAY IN THE LIFE OF CINDY SHIVELY’: MAGAZINE.NURSING.VIRGINIA.EDU
“This is work you get to do, not something you end up doing. There’s a real difference.”
Caroline McKinnon (MSN ’02)
1. Heseltine, J., & Heath, J. (2015). History of mental health nursing: The Royal College of Nursing. Retrieved from http://mht.rcnlearning.org.uk/Information/ 2. Ozarin, L. (2006). Diseases of the Mind: Highlights of American psychiatry through 1900. U.S. National Library of Medicine. Retrieved from https://www.nlm .nih.gov/hmd/diseases/index.html 3. Ibid. 4. Ibid. 5. Heseltine, J., & Heath, J. (2015). History of mental health nursing: The Royal College of Nursing. Retrieved from http://mht.rcnlearning.org.uk/Information/ 6. Ibid. 7. Kalisch, P., & Kalisch, B. (2004). American Nursing: A History. Philadelphia: Lippincott Williams & Wilkins. 8. Community Mental Health Journal, 19(2), 1983. 9. Circular of Nursing, UVA School of Nursing, 1938. 10. 2017 AANP National Nurse Practitioner Sample Survey
ON M Y BOOKSHELF
Richard Westphal WOODARD CLINICAL PROFESSOR OF NURSING AND CHAIR, FAMILY, COMMUNITY, AND MENTAL HEALTH DEPARTMENT
CURRENTLY READING Death, disasters, and mayhem—that’s the genre. It’s reading to try and get better understanding of the effects of disasters, of trauma, of general mayhem on people’s lives, and more importantly, what we can do about it. One book I’m revisiting, though, is Viktor Frankl’s Man’s Search for Meaning. I come back to it all the time. FAVORITE ASSIGNED READING Depends upon the course. For my evidence-based practice course, it’s Evidence Based Practice in Nursing and Healthcare, which is foundational. But with our movement toward articles, I routinely draw from World Views in Evidence-Based Practice, from Sigma Theta Tau International. For theory, I use Nursing Scholarship, and then, of course, there’s the Archives of Psychiatric Nursing. FOR FUN My relaxation reading genre is science fiction, specifically the genre of future history where you take something that’s current and project it out 50, 100 years. My absolute favorite author is Robert Heinlein, who wrote A Stranger in a Strange Land. The commentary on today’s society and belief system is absolutely spot-on. FAVORITE SPOT TO READ In our house, we have a room that is a Wi-Fi dead zone: No electronics, the lighting’s subdued, it’s wellinsulated and quiet. Some call it a guest bedroom. But it’s where I prefer to read. UP NEXT A new translation of Dostoevsky’s The Brothers Karamazov because, when I was an undergraduate at the University of Minnesota, I thought I learned more about the human condition in my humanities class on Eastern European literature than I ever did from my nursing textbooks. There’s also Chekov’s The Cherry Orchard for role of memories in the struggle of past and present, and Thomas Mann’s Magic Mountain to understand institutionalization, and the human experience of being in an asylum, a jail—or at a university! These books are for that.
Wall, B. M. & Brown, B. J. (2017). Through the eyes of Nursing: Educational reform at the University of Texas School of Nursing, 1890-1989.
Barbarash, E., Doernberg, D., Phillips, E.K., Zinner, D., Rein, M., & Low, D. (2017). Safety precautions for Taharah: A guide to personal protection while performing the holy work of the Chevrah Kadisha. Middletown, DE: Kavod v’Nichum.
White, K.R., & Fontaine, D. (2017). Boost Your Nursing Leadership Career: 50 Lessons That Drive Success. Chicago: Health Administration Press.
PUBLICATIONS HIGHLIGHTS Alhusen, J. L., Geller, R., Dreisbach, C., Constantoulakis, L., & Siega-Riz, A. M. (2017). Intimate partner violence and gestational weight gain in a population-based sample of perinatal women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 390-402. Byon, H., Zhu, S., Unick, G., Storr, C., & Lipscomb, J. (2017). Language barrier as a risk factor for injuries from patient violence among direct care workers in home settings: Findings from a US national sample. Violence and Victims, 32(5), 858-868. Coyne, B., Hallowell, S., & Thompson, M. T. (2017). Measurable outcomes after transfer from pediatric to adult providers in youth with chronic illness. Journal of Adolescent Health, 60(1), 3-16. Cunningham, T., Rosenthal, D., & Catallozzi, M. (2017). Narrative medicine practices as a potential therapeutic tool used by expatriate Ebola caregivers. Intervention, 15(2), 106-119. Curley, D., Short, N., Loriz, L., Sochalski, J., Anderson, A., Anderson, C., Brennan, P., Burnett, C., Lafevers, D., Martinez-Rogers, N., & Waddell, A. (2017). American Association of Colleges of Nursing Faculty Policy Think Tank Report and Recommendations (Report). Retrieved from http://www.aacnnursing.org/ Portals/42/Policy/PDF/FPTT-Report-10-122017.pdf. DeGuzman, P. B., Cohn, W. F., Camacho, F., Edwards, B. L., Sturz, V. N., & Schroen, A. T. (2017). Impact of urban neighborhood disadvantage on late stage breast cancer diagnosis in Virginia. Journal of Urban Health, 94(2), 199-210. Donesky, D., Selman, L., McDermott, K., Citron, T., & Howie-Esquivel, J. (2017). Evaluation of the feasibility of a home-based TeleYoga intervention in participants with both chronic obstructive pulmonary disease and heart failure. Journal of Alternative and Complementary Medicine, 23(9), 713-721. Epstein, E., Arechiga, J., Dancy, M., Simon, J., Wilson, D., & Alhusen, J. (2017). Integrative review of technology to support communication with parents of infants in the NICU. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 357-366. Gibson, M. E. (2017). An early history of anesthesia in labor. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(4), 619-627. Keim-Malpass, J., Mitchell, E. M., Sun, E., & Kennedy, C. (2017). Using Twitter to understand public perceptions regarding the #HPV vaccine: Opportunities for public health nurses to engage in social marketing. Public Health Nursing, 34(4), 316-323.
LeBaron, V. T., Palat, G., Sinha, S., Kumari Chinta, S., Jamina, B. J., Pilla, U. L., â€Ś & Beck, S. L. (2017). Recommendations to support nurses and improve the delivery of oncology and palliative care in India. Indian Journal of Palliative Care, 23(2), 188-198. Letzkus, L. C., Keim-Malpass, J., Anderson, J., & Kennedy, C. (2017). Paroxysmal sympathetic hyperactivity in children: An exploratory evaluation of nursing interventions. Journal of Pediatric Nursing, 34, e17-21. Logan, J. G., & Yeo, S. (2017). Effects of stretching exercise on heart rate variability during pregnancy. Journal of Cardiovascular Nursing, 32(2), 107-111. Moon, R. Y., Hauck, F. R., Colson, E. R., Kellams, A. L., Geller, N. L., Heeren, T., Drake, E. ... & Corwin, M. J. (2017). The effect of nursing quality improvement and mobile health interventions on infant sleep practices: A randomized clinical trial. Journal of the American Medical Association, 318(4), 351-359. Msaouel, P., Gralla, R. J., Jones, R. A., & Hollen, P. J. (2017). Key issues affecting quality of life and patient-reported outcomes in prostate cancer: An analysis conducted in 2128 patients with initial psychometric assessment of the prostate cancer symptom scale (PCSS). BMJ Supportive & Palliative Care, 7(3), 308-315. Quatrara, B., Rea, K., Wilkins, K., & Facteau, L. (2017). Partnering to improve outcomes: The nurse executive and the clinical nurse specialist. Nurse Leader, 15(1), 61-64. Romo, R. D., Allison, T. A., Smith, A. K., & Wallhagen, M. I. (2017). Sense of control in end-of-life decision-making. Journal of the American Geriatric Society, 65(3), e70-75. National Academies of Sciences, Engineering, and Medicine, and the Committee on Food Allergies (which includes Siega-Riz, A.M.). (2017). Finding a path to safety in food allergy: Assessment of the global burden, causes, prevention, management, and public policy (Report). Washington, DC: The National Academies Press. Williams, I. C., Park, M., Tsang, S., Sperling, S. & Manning, C. (2017). Cognitive function and vascular risk factors among older African American adults. Journal of Immigrant and Minority Health, 1-7. Advance online publication. Wall, B. M., & Keeling, A. (2017). Historical highlights in disaster nursing. In J. TruglioLondrigan & S. Lewenson (Eds), Public health nursing: Practicing population-based care (3rd ed., pp. 377-391). Boston: Jones and Bartlett Publishers. + A FULL LIST OF UVA NURSINGâ€™S FACULTY PUBLICATIONS IS AVAILABLE ONLINE NURSING.VIRGINIA.EDU/FACULTY -PUBLICATIONS
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Morton, P. G., & Fontaine, D. K. (2018). Critical Care Nursing: A Holistic Approach. Philadelphia: Wolters Kluwer Health.
SECRETS UNDER ICE New biological repository births scholarly possibilities BY CHRISTINE PHEL AN KUE TER
magine it: an ordinary freezer—not unlike the one in your basement or garage—with hundreds of neatly packaged test tubes offering clues about the interplay between a pregnant woman’s biology and her baby, and a very real chance to
average temperature of stored ONOS samples
improve the mental and physical health outcomes of both. That’s the promise that ONOS—the Obstetric and Neonatal Outcomes Study cohort, a repository of serum, cord blood, stool, and placental tissue from local pregnant women—offers. “The data are extremely rich,” says Anna Maria Siega-Riz, associate dean for research, who, with UVA obstetrics chief Donald Dudley, is assembling the biological repository. “And while it’s fodder for scholarly papers, these specimens also offer endless suggestions for preliminary areas of exploration. The opportunities here—for nurses, physicians, PhD students— are incredible.” Siega-Riz herself is no stranger to big data. The nutrition and maternal-child health scholar is currently part of a $2.5 million National Institutes of Health (NIH) grant examining diet-related outcomes and pregnancy, and part of the NIHfunded Hispanic Community Health Study of Latinos that’s tracking health information on more than 16,400 Latinos. After 20
her arrival at UVA in 2015, she and a School of Medicine team began assembling the ONOS cohort by asking pregnant women receiving treatment at UVA to contribute specimens to the new repository, kept under lock and key in the bowels of UVA Medical Center. And the women, it turns out, have been only too happy to help. Specimens from more than 200 individuals lay waiting in tidy, labeled test tubes for a researcher to come and unlock their secrets. Someone like Caitlin Dreisbach. Dreisbach (right), a long-time labor and delivery nurse and a PhD student concurrently earning a master’s in data science, will be, with UVA psychology student Caroline Kelsey, the first scholar to mine the samples’ riches. The duo earned a Presidential Fellowship (funded by UVA’s Data Science Institute) and plan to investigate how mothers’ microbiomes—the flora in the gut not unique to our bodies—may predict emotional connectivity and responsiveness to their babies. Dreisbach and Kelsey will begin recruiting ONOS participants for their follow-up study in January 2018, and later this fall will begin work to sequence the specific strains of bacteria in those samples. Ultimately, they plan to enroll 100 moms and babies, study their diets, get stool and blood samples at regular intervals to assess their microbiomes, and conduct a variety of psychological tests related to mental health, stress, and anxiety. “We know that babies are best understood in the context of the way they’re nurtured and raised,” explains Dreisbach, “and that it’s likely that the microbiome may not only influence moms’ mental health, but babies’ neurological growth, too. The questions I’m interested in are directly related to challenges I see women go through during delivery, and afterwards. It’s really grounding work.” It’s also providing an academic foothold for Dreisbach, who ultimately hopes to be a nurse scientist and academic. “I don’t think I’d be doing this anywhere else,” says Dreisbach, “because nowhere else do they offer the support to combine things the way I have. We have a Data Science Institute that firmly believes that nurses need to be part of the conversation, and a nursing school that thinks that I can and should be doing real work like this.” “There are so many potential research papers here, so many collaborations to be made, not only in infant development and maternal health, but also in pregnancy, nutrition, and the microbiome as a whole,” she adds. “That’s been the biggest gift.” +
It’s likely that the microbiome may not only influence moms’ mental health, but babies’ neurological growth, too.
ON THE ROAD 22–33%
HIGHER Number of deaths from cervical cancer in Southwest Virginia, compared to the rest of the Commonwealth 1
BY JE S SIC A EUS TACE
esults from several pilot studies and the Cleveland Clinic’s recent high praise for human papilloma virus (HPV) self-collection tests have put an extra spring in Assistant Professor Emma Mitchell’s (MSN ’08, PhD ’11) step. Not just because the tests were declared a top-ten innovation for 2017 by the famed clinic, but because, thanks to a generous gift Learn more about from Pat (BSN ’69) making an impactful gift. and Keith Woodard Contact Kelly McCaskill, (A&S ’71, MBA ’75), executive director of Mitchell will be development: (434) 924-0097 able to reach even email@example.com more rural women with the selfcollection tests, which detect the most dangerous strains of HPV that cause cervical cancer. It’s a novel delivery method for a novel test. Already, during the summers of 2016 and 2017, Mitchell paired mobile mammography appointments with cervical cancer screenings for women 22
receiving care at the annual Remote Area Medical clinic and en route in UVA’s Mobile Mammography bus. Now, the Woodards’ funding will build on previous work funded by the UVA Cancer Center in which Mitchell and her team of students worked extensively with communitybased partners to train “lay navigators” who do home visits with rural women to explain how the screening works and how the kits are used. With help from the $25,000 gift, Mitchell and her team hope to recruit 70 more women in 2018 to take the self-collection tests in regions of Virginia especially hard hit by cervical cancer. What’s already been learned is sobering: Between 15 and 16 percent of rural women tested positive for the high risk HPV strains that cause cervical cancer, a group that Mitchell and her team of navigators then counseled about next steps for follow-up care. Distribution of the HPV tests on the mobile mammography bus “offered us
a natural and low-cost way to catch cancer early, resulting in significant savings in testing and treatment costs down the road,” explains Mitchell. “Quickly caught, cervical cancer is quite treatable. It’s when it goes undetected that it becomes deadly. We’re hoping that taking the tests and our message on the road will help make it less so.” While the HPV vaccine—commonly administered in two doses to boys and girls between ages 9 and 26— is improving infection rates in the U.S., women who aren’t eligible for the
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vaccine or who lack access to primary care due to their geography, insurance, or financial status aren’t so lucky. In many rural areas, including Southwest Virginia, cervical cancer deaths are a quarter to a third higher than elsewhere in the state. Internationally, the picture is even more bleak, with women in developing countries dying at rates that that, in some cases, are seven times higher than in the U.S.2 Currently, Pap tests—where cervical cells are collected by a doctor or nurse practitioner in a clinic and then sent to a
lab that can detect abnormal cells under a microscope—are recommended every three years for women ages 21 to 29, and every five years when administered with HPV testing for women ages 30 to 65. Between 50 million and 60 million Pap tests are done each year in the United States, about 3.5 million of which require follow-up. The Woodards’ gift also strengthens Mitchell’s proposal to the National Institutes of Health, which, if earned, would exponentially impact at-risk women, nursing students and faculty,
and the School and University as a whole. All from a $43 kit. “We’re really passionate about helping underserved populations in rural areas,” says Pat Woodard from her home in Norfolk, Va. “This project is a perfect fit for how we want to make a difference.” + 1. Cancer Incidence Rate by Health District, Cervix, Virginia, 2004– 2008. Virginia Cancer Registry, Virginia Department of Health. 2. Luciani, S., Cababes, A., Prieto-Lara, E., & Gawryszewski, V. (2013). Cervical and female breast cancers in the Americas: Current situation and opportunities for action. Bulletin of the World Health Organization, 91(9), 640-649. Retrieved from http://www.who.int/ bulletin/volumes/91/9/BLT-12-116699-table-T2.html.
NURSING ALUMNI AS SOCIATION
From the President
uch has happened since my last letter to you. Last fall, I had the honor of representing the School of Nursing Alumni Association (SONAA) at the undergraduate awards ceremony in Old Cabell Hall when second-year students were presented with their white coats, signifying their entry into clinical practice, as first-, third-, and fourth-year students received their class pins. It was also my privilege to present awards to three outstanding faculty members on behalf of the SONAA.
LINNE A DAVIS
Then, in February, I joined Dean Fontaine at New York City’s Yale Club to gather with nursing alumni, parents, friends, and donors in the region. As always, I came away impressed by the exceptional people I met, from those who were just beginning their careers to Individuals entering retirement after lengthy and distinguished professional careers. There were many “it’s such a small world” moments as we mingled before hearing from the dean, who shared news of exciting School initiatives and then took questions from the group. Three Alumni Council members’ terms will end June 30. Thank you, Linda Halpin (BSN ’75), our scholarship coordinator, Sandy Reed-Bryant (BSN ’78, MSN ’86), our finance coordinator, and Page Dunbar (BSN ’11, MSN ’17), our young alumni engagement liaison, for your tireless commitment to the SONAA and the School. You have made our organization stronger, and we wish you much enjoyment with your new-found time! We also welcome three new members July 1— Kelley McKeta Anderson (BSN ’88), Allyson Wells Bakewell (BSN ’81), and Shannon McDonald (BSN ’16)—and are eager to capitalize on their energy, expertise, and enthusiasm (read about them on p. 25).
As you read Virginia Nursing Legacy, I urge you, too, to pick up UVA president-elect James Ryan’s best-selling book, Wait, What? And Life’s Other Essential Questions (HarperCollins, 2017). In it, Ryan frames five important questions to consider, with a bonus query at the end. It was that bonus—titled “Late Fragment,” from a poem by Raymond Carver—that I found most compelling. And did you get what you wanted from this life, even so? I did. And what did you want? To call myself beloved, to feel myself beloved on this earth. (From A New Path to the Waterfall, Atlantic Monthly Press, 1989) “The ‘even so’ at the end of the question, to me,” writes Ryan, “perfectly captures the reality that pain and disappointment are inevitably a part of a full life, but also the hope that life, even so, offers the possibility of joy and contentment.” I believe for many of us, as University of Virginiaeducated nurses, this statement rings true. We know that we cannot erase all the pain and suffering of our patients, yet we push forward, even so, working to make this world a better place and touching the lives of those around us. Sincerely,
Christa Hartch (BSN ’97) Greenwich, Connecticut
UVANursing groups/4248973 uvason uvaschoolofnursing
Alumni Council 2017–2018 McDonald
All School of Nursing graduates, Alumni Council members oversee the SONAA by serving three-year terms. Christa E. Hartch (BSN ’97) Greenwich, CT President Amanda Faircloth (BSN ’00) Richmond, VA Vice-President
Page Dunbar (BSN ’11, MSN-FNP ’17) Alumni Engagement Coordinator — Young Alumni Charlottesville, VA
Three New Members Join Council
corporate recruiter with Ciena Healthcare in Detroit, Mich., Allyson Wells Bakewell (BSN ’81) leads the talent acquisition team for this rapidly growing long-term care management company. July 1 marks the beginning of her term as finance coordinator. Bakewell started her career in a cardiovascular intensive care unit at Emory University Hospital. As a consultant for Deloitte, she worked with hospitals in Texas, New Jersey, New York and, now, Michigan. With an MBA from the Cox School of Business at Southern Methodist University, Bakewell first joined the Alumni Council Finance Committee in 2007, evaluating proposals for funding from faculty, staff, and students. For more than a decade, Bakewell served on the New Jersey-based Medical Needs Foundation board, a group that provides financial assistance to families and individuals facing catastrophic or chronic illness. Since its 1998 founding, the Foundation has distributed more than $1.8 million to people in need. Kelley McKeta Anderson (BSN ’88)— an associate professor at Georgetown University School of Nursing & Health Studies, who teaches CNL, DNP, and undergraduate students enrolled in the honors program—joins the Council as scholarships coordinator. A family nurse practitioner, Anderson works in cardiology at MedStar, Georgetown
University. She earned an MSN from the University of Texas at Austin, an FNP certificate from the University of Florida, and a PhD from Catholic University. Anderson was editor of The Advanced Practice Nurse Cardiovascular Clinician, which is focused on guiding advance practice nurses and their interprofessional teams across a variety of care settings, published in 2015. She has been involved with the Alumni Council Scholarships Committee for nearly a decade as part of the team that determines SONAA-awarded scholarship and fellowship recipients. Shannon McDonald (BSN ’16) works as an emergency department nurse at UVA Medical Center, and has been active in engaging new graduates since walking the Lawn herself in 2016. Now an MBA student with long-term ambition to work in hospital administration, improving procedures and working conditions for her fellow nurses, McDonald assumes leadership of SONYA— School of Nursing Young Alumni—July 1. +
Bylaws Update At a winter retreat, the Alumni Council voted to adopt additional changes to its bylaws. We ask all nursing alumni to review the bylaws at nursing.virginia .edu/alumni and vote online, emailing comments to nursing-alumni @virginia.edu by June 30, 2018.
Linda Halpin (BSN ’75) Scholarships Coordinator Annandale, VA Carleen Kelley (BSN ’81) Alumni Engagement Coordinator — Special Projects McLean, VA Matthew Lemieux (MSN-CNL ’11, PNP ’15) Communications Coordinator Crozet, VA Sandy Reed-Bryant (BSN ’78, MSN ’86) Finance Coordinator Williamsburg, VA Susan Winslow (MSN ’87, DNP ’13) Alumni Engagement Coordinator – Volunteer Outreach Williamsburg, VA Sara Wassel (BSN ’09, MSN-FNP ’14) Awards Coordinator Greenwich, CT Rebecca Harmon (PhD ’03) Faculty Representative Staunton, VA Nicole Jefferson (BSN ’18) Student Representative Cumberland, VA Want to help? Get involved with your SONAA by joining an Alumni Council committee! We currently need committee members for the School of Nursing Young Alumni (SONYA) group for its awards, scholarship, communications and finance committees. Contact us for information: firstname.lastname@example.org +
NURSING ALUMNI AS SOCIATION
Assistance for Alumni Nursing Alumni Association Alumni Scholarship All UVA Nursing alumni returning for an advanced degree or certificate in nursing at any institution may submit their application by June 1. Information and application online: nursing.virginia.edu/alumni/stay-engaged/
Tabitha S. Grier Medical Assistance Fund UVA Nursing alumni facing medical expenses not covered by insurance, Medicaid, or Medicare may apply by August 1. Information and application online: nursing.virginia.edu/alumni/stay-engaged/
Seeking feedback from Graduate Alumni! Do you have photographs, letters, or other memorabilia from your time as a UVA School of Nursing student or from the early days of your nursing career? Consider donating these items to the Eleanor Crowder Bjoring Center for Nursing Historical Inquiry to help preserve nursing history. Contact us: email@example.com or (434) 924-0083.
Homecomings 2018 Celebrate With Us October 13!
oin us at Pavilion IX to visit with nursing alumni, students, faculty, and friends before the UVA vs. Miami football game on Saturday, October 13, 2018. Update your contact information to make sure youâ€™re invited: firstname.lastname@example.org. +
Alumni Council member Carleen Kelley (BSN â€™81) wants to hear your thoughts and ideas on how our graduate alumni wish to stay engaged with the School of Nursing. Add your feedback by emailing Carleen: email@example.com. +
1958 1963 1968 1973 1978 1983 1988 1993 1998 For information on nursing alumni events, contact the Alumni and Development Office: (434) 924-0138 To register for your reunion weekend, contact the UVA Alumni Association: (434) 243-9000, or visit: virginiareunions.com
35th, 40th, 45th, 50th, 55th, and 65th Reunion Classes and the Thomas Jefferson Society Classes of 1983, 1978, 1973, 1968, 1963, and 1958 Celebrating Reunions May 31–June 3, 2018 Friday, June 1 Nursing Building Tours: McKim Hall, McLeod Hall, Claude Moore Nursing Education Building 10–11:30 a.m. Meet in the McLeod Hall lobby at 10 a.m. Faculty and students will lead tours. Diploma Reception honoring the final class of Diploma graduates on the occasion of their 50th Reunion, 5–6:30 p.m. Eleanor Crowder Bjoring Center for Nursing Historical Inquiry, McLeod Hall
Saturday, June 2 50th Reunion and Thomas Jefferson Society Luncheon 12–1:30 p.m. Newcomb Hall Ballroom Nursing Alumni Reception 4–6 p.m. Pavilion IX Garden, West Lawn
BE A MEN TOR! CALLING ALL UVA NURSING ALUMNI! Want to inspire the next generation of your colleagues? We need nurse practitioners to mentor current students. Become a preceptor! Email Christine Kennedy, associate dean for academic programs: firstname.lastname@example.org +
5th, 10th, 15th, 20th, 25th, and 30th Reunion Classes Classes of 2013, 2008, 2003, 1998, 1993, and 1988 Celebrating Reunions June 8–10, 2018 Friday, June 8 School of Nursing Open House 2–3:30 p.m. McLeod Hall, Claude Moore Nursing Education Building Meet in the McLeod Hall lobby for a self-guided tour of McLeod Hall and the Claude Moore Education Building. Stop by the Clinical Simulation Learning Center and the Resilience Rooms to talk with students and faculty.
Saturday, June 9 Nursing Alumni Picnic Lunch 12–1:30 p.m. Pavilion IX Garden, West Lawn 27
CL AS S NOTES AND NE WS 4
3 7 6
1970s The “Christmas Elves”—comprised of Candy Darnall Powell, Denez Williams Yancey, Sarah (Rusty) Flint Wilder, Mary Ann Hancock Justice, and Judy Dowty Pittard (all BSN ’70)—continues the tradition they began as fourth year nursing students at UVA when they celebrated the holidays together before leaving for winter break. Since then, with the addition of husbands and children, the group continues to gather each year, as they did last winter in Rockingham County, VA, at the home of Judy. 1 The Charleston Gazette-Mail featured veteran school nurse Brenda Isaac (BSN ’72), of Charleston, WV, in a December 2017 article in which she expressed gratitude to her high school guidance counselor for urging her to earn a nursing degree at UVA.
Janice Rosser Allen (BSN ’75), of Fort Monroe, VA, published her first book, God in the Crossroads: Signs of Hope (Tate Publishing, 2016), which chronicles her experiences as CEO of International Cooperating Ministries. 2
1980s Terrie Haller (MSN ’87) received the Nancy Vance Award from the Virginia Nurses Association (VNA) at its annual gala in Richmond, the VNA’s highest honor. “Honored, humbled, and thrilled,” says Terrie, of Charlottesville, VA, of the distinction, and “grateful for the mentorship I received from my University of Virginia Medical Center and School of Nursing colleagues.” 3 Claudia Barone (MSN ’88), a national expert in tobacco cessation, was named the Nicholas P. Lang, MD, and Helen F. Lang, RN, Endowed Chair at the University
of Arkansas for Medical Sciences, in Little Rock, AR, last June. Claudia lives in Little Rock, AR.
2010s Last November, Cat Herrington Elmore (CNL ’11) and Carol Morrill (MSN ’16) were honored as ‘Health Literacy Champions’ by UVA Health System’s patient and family education committee for their work with non-English speakers and recent refugees. Cat, who’s enrolled in the PhD program at the School, lives in Spotsylvania, VA; Carol lives in Charlottesville, VA. 4 Debra Levin (BSN ’12, MSN ’14) earned Bon Secours’ Advanced Practice Clinician Award last October for championing the values of respect, justice, integrity, innovation, compassion, quality, and growth. Debra is a nurse practitioner at the Heathsville Family Practice, northeast of Richmond, and lives in Richmond, VA.
Last September, Elizabeth Collins (BSN ’13) of Raleigh, NC, was named Children’s Services Employee of the Month at the University of North Carolina Children’s Hospital in Chapel Hill, NC, for “going above and beyond for her patients, their families and coworkers.” Last September, Robin Hills (DNP ’14), of Richmond, VA, became the deputy executive director for advanced practice with the Virginia Department of Health Professions. On May 20, 2017, Milly (Macadam) Muffly (BSN ’14) and Brian Muffly (COL ’13) were married in Atlanta, GA. Milly works as a nurse
In Memoriam 1930s
Francis H. McGovern (DIPLO ’32) Danville, VA AUGUST 19, 2017 Ann Kirby (DIPLO ’35) Louisa, VA SEPTEMBER 10, 2017
Marilyn S. Booker (DIPLO ’43) Callao, VA AUGUST 27, 2017 Mary D. Hill (DIPLO ’44) Wakefield, RI FEBRUARY 12, 2013 + Norma S. Waldbauer (DIPLO ’44) Winston-Salem, NC AUGUST 30, 2017 Helen T. Whitescarver (DIPLO ’44) Roanoke, VA DECEMBER 8, 2017 Peggy S. Floyd (DIPLO ’45) Charlottesville, VA FEBRUARY 6, 2018 Mae T. Downey (DIPLO ’46) Elkton, VA NOVEMBER 10, 2017 Sue Conrad (DIPLO ’47, CERTI ’78) Weems, VA JANUARY 20, 2018 Nancy M. Knight (DIPLO ’47) Williamsburg, VA AUGUST 14, 2017
specialist at the Lexington-Fayette County Health Department, a public health clinic in Lexington, KY, where the couple resides. 5 The Virginia Nurses Association recognized Ashley (Browne) Wade (BSN ’15) with its Direct Patient Care Leader-Patient Safety award at its annual gala last fall, which recognizes nurse leaders who demonstrate exceptional commitment to patient safety. Ashley works as a clinician IV in the ICU at UVA Medical Center, and lives in Palmyra, VA. 6 The Chesterfield (VA) Fire Department and EMS honored Gray Smith (BSN ’16) with a Bronze Valor Award last November for his
team’s work to rescue a 13-year-old girl and her family. Gray lives in Powhatan, VA. 7 Amalia Belcher (MSN ’12, COL ’07), who works as a nurse on 4 and 5 Central, was elected president of UVA Medical Center’s Professional Nursing Staff Organization. Amalia lives in Charlottesville, VA. Last September, Jessica Borchert (BSN ’15) of Arlington, VA, was nominated for the Daisy Award by her George Washington University Hospital colleagues. The Daisy Award recognizes extraordinary nurses and honors “the superhuman work nurses do for patients and families every day.” +
Louise May Swing (DIPLO ’47) Troy, VA MAY 8, 2014 +
Jean T. Ballou (BSN ’58) Harrisonburg, VA SEPTEMBER 10, 2017
Mary S. Sandridge (DIPLO ’48) Charlottesville, VA JANUARY 3, 2018
Sandra B. Brodell (DIPLO ’58) Saint Michaels, MD DECEMBER 12, 2013 +
Janet H. Brown (DIPLO ’49) Saint Simons Island, GA OCTOBER 12, 2017
Betty Hinkle Whitley (BSN ’59) Norristown, PA AUGUST 13, 2017
Jean H. Turman (DIPLO ’49) Charlottesville, VA AUGUST 30, 2018
Susan E. Griffith (BSN ’64) Midlothian, VA DECEMBER 1, 2017
Pricilla R. Zboray (DIPLO ’50) Longview, TX SEPTEMBER 14, 2017
R. Ellen Gore (BSN ’65) Castleton, VA JANUARY 11, 2018
Mary Blankemeier (DIPLO ’51) Oceanside, CA SEPTEMBER 11, 2017
Jeanne W. Derington (BSN ’66) Huntsville, AL AUGUST 12, 2017
Julie Dennis Howard (DIPLO ’51) Charlottesville, VA AUGUST 24, 2017
Kay DeYoung Brown (DIPLO ’54) Charlottesville, VA FEBRUARY 10, 2018 Margaret E. Fletcher (BSN ’54) Williamsburg, VA NOVEMBER 9, 2017 Ann Gray Norris (BSN ’56) Henrico, VA NOVEMBER 16, 2017 Elinor O. Bruinsslot (BSN ’57) Northridge, CA AUGUST 2, 2017 Theodora S. Haddock (BSN ’57) Colorado Springs, CO JANUARY 24, 2018
Linda Krongaard DeMong (BSN ’86, MSN ’88, CERTI ’74) Charlottesville VA DECEMBER 19, 2017
Chris C. Waddell (BSN ’01) Pennington Gap, VA JUNE 2, 2014 +
Kevin M. Shimp (MSN ’11) Shackleford, VA FEBRUARY 10, 2018 William P. Gregg (MSN ’15) Palm Desert, CA OCTOBER 9, 2017 +
+ While the School of Nursing strives to be timely, we just received notice of these alumni deaths since our last publication.
GETTING BY JE S SIC A EUS TACE
ROBER T MERHAU T
ith all the healthcare challenges in the U.S. today, it’s imperative that policy and politics be informed by nursing practice. That’s been true for critical care nurse Liz Stokes (BSN ’02), who found herself in a fast-paced, high-stakes environment that left little time for her to catch her breath, care for herself, and reflect. Watching coworkers repeatedly grapple with ethical dilemmas that caused them physical and emotional distress led Stokes to a “light bulb moment.” That moment, in turn, sparked her entry into law school, and, ultimately, led to a job at the intersection of care and policy at the American Nurses Association (ANA). “It didn’t take long for me to realize the immense challenges this country faces in healthcare and nurses face in their work,” Stokes says. “I discovered there were hundreds of nurse attorneys doing so many different things, and was excited to learn there were other ways to continue serving patients and the profession.” Director of the ANA Center for Ethics and Human Rights, Stokes writes about public policy focused on ethical issues like assisted death and women’s reproductive health, and topics revolving around care for individuals with intellectual disabilities. And though she’s no longer cruising through a hospital corridor or tending patients at the bedside, Stokes says she’ll always be a nurse first. “Nursing is truly a calling, and a part of my personal lens in how I view the world,” she says. “I’m honored and proud to be a nurse, and will continue to advocate for patients who don’t have a voice, and for nurses across the country.” +
1972 The year Texas Democrat Eddie Bernice Johnson became the first nurse elected to the U.S. Congress.
I NEVER INTENDED TO GET INTO POLITICS.
hen Hurricane Katrina hit the Gulf Coast in 2005, Kellen Squire (BSN ’11), who’d been training as a paramedic, walked into his local Red Cross office and asked to help. “I told them I’d do anything,” recalls Squire, today an ER nurse at Sentara Martha Jefferson Hospital, living in Barboursville. “Drive trucks, clean, hand out supplies—I just wanted to go.” Arriving in Biloxi, Ms., the devastation was like nothing he’d ever seen. Equally life-changing was the group of nurses to which he was assigned. “These nurses were, well, everything,” explains Squire. “There were no hospitals, doctors, ambulances, electricity, running water—they filled every niche that needed it without hesitation or a single complaint. And two weeks later, as Hurricane Rita eyed the shore, they wouldn’t leave. Every single nurse in our group refused to
But as an ER nurse, you get a unique view other people don’t have … And I saw problems and knew I needed to get to work.” go. And that’s why I’m a nurse today.” That same stubborn determination to help—plus the issues he saw as an emergency room nurse that needed fixing—compelled Squire in 2017 to run as the Democratic candidate for District 58 of the Virginia House of Delegates. And while he didn’t win the seat, his spirited campaign led to the highest voter turnout ever in his district, shaking up the status quo. “I never intended to get into politics,” says Squire. “But as an ER nurse in particular, you get a unique
view on the community that other people don’t have. We’re the safety net. I saw problems in our community, and I knew I needed to get to work.” Would he do it again? Possibly. The only thing he’s sure of is that he’ll keep on being a nurse—and a passionate advocate for other nurses. “I love being an ER nurse,” Squire says, “and I’m going to try to convince as many nurses as possible to stand up and advocate for our profession. We have enormous power to accomplish great things, if we work together.” + 31
IN THEIR OWN WORD S
Air hugging an angel First day on the inpatient psychiatric floor, my periwinkle student scrubs crisp but heavy around my tingling skin— that’s when I meet her. You see, suddenly her eyes glue to mine in the most intense, still way, her deep indigo blue glossy eyes Is there anyone there? Like a hummingbird my dark brown eyes tucked behind a pair of new tortoise shell glasses nervously dart back And forth under her concentrated stare until eventually I give up—I wouldn't stop letting her see inside of me What do you see? “Jesus loves you.” We didn’t cover this in class yet, but I nod “He knows you. Everything about you.” And I still stare into those deep sea eyes, lost Swimming in them, peacefully and recklessly at the same time “Your friend died, didn't she? You had a friend that died.” And a chill washes over me and she adjusts her gaze like a camera trying to focus like she’s trying to see a part of me that’s tucked away Deep down Her eyes turn soft and we continue down that linoleum hallway, the wheels of her walker Chiming in and we talk like old friends, slow and childish about rabbits Having good eyesight because they eat so many carrots and baby deer being so beautiful, too beautiful to kill and I smile and she smiles
And she asks if I use Colgate to brush my teeth. And then, as if she saw them for the first time, she notes “Your eyes are brown. Do you know what they say about people with brown eyes?” I lean in, anxious to hear: “You are smart.” It was as if she knew my insecurities, my quiet inner doubts of whether I was meant to be here, the ones that chisel the inside of my stomach and make my heart hammer in my ears “He will help you. ‘I can do all things in Christ who strengthens me.’” And a sense of peace flurries down on me, like a fresh miraculous snow “I wish I could give you a hug but there is that rule about touching here,” she sulks. “We can air hug,” I suggest and her face lights up and her eyes laugh, like shiny stones, radiant sapphires “An air hug! I never heard of that!" And it was by far the most meaningful hug I’d received in weeks. Then gently, I close the door, watching her beaming mysterious unforgettable face disappear behind the thick wooden slab. But I couldn’t stop thinking about her: the hyper-religious, delusional, auditory hallucinative, schizoaffective patient And that night I find myself peering into my own eyes a little deeper, a little deeper. How did she see? What did she see? And then I proceed to brush my teeth with a tube of toothpaste that read Colgate.
LISTEN TO BUONGIORNO READ HER POEM: MAGAZINE.NURSING.VIRGINIA.EDU
COE SWEE T
— Emily Buongiorno (CNL ’18) (from Newtown Square, Pa.)
VIRGINIA MOMENT S
AND THE WORRIED WELL
hen thinking about the history of psychiatric nursing, consider the Mental Health Act of 1946, which provided federal funding to establish the National Institutes of Mental Health (NIMH), educated mental health practitioners, and spurred the development of graduate mental health nurse education programs across the United States. This was the era when nurses like Hildegard Peplau introduced the concept of a “therapeutic nurse-patient relationship” and implemented the first psychiatric advanced practice role, the Clinical Nurse Specialist (CNS). CNSs were taught to care for the community and the individual by providing a healing experience for each patient, much as Florence Nightingale had recommended a century earlier. During the anxiety-riddled age of the 1950s, when psychoanalysis grew popular and focus expanded on the
“worried well,” nurses distributed pamphlets like these at mental hygiene and child guidance clinics and schools. These are from the collection of Alice Constance (Burford) Booth (1920–2004), of Amherst, Va., head nurse in the psychiatric unit at the Medical College of Virginia where she later taught psychiatric nursing for more than two decades. Yet, health systems remained stubbornly segregated mid-century, prompting the establishment, in 1970, of the Center for Minority Mental Health within the NIMH, headed by African-American nurse Mary Stark Harper who led in this capacity for 20 years. By the late 1990s, the psychiatric mental health nurse practitioner role met the needs of rural communities, and today, the CNS and NP roles have merged to meet mental health needs across the lifespan. +
F ROM THE ALICE CONS TANCE (BURFORD) BOOTH COLLEC TION (1920 –2004) IN THE BJORING CENTER FOR NURSING HIS TORIC AL INQUIRY.
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CHANGE SERVICE REQUESTED
MAY 2018 6–12 National Nurses Week 10
LGBTQ+ Health Care Summit: Embracing inclusion & diversity for the whole patient
End of spring semester examinations
School of Nursing pinning and hooding ceremonies
Deadline to apply for Nursing Alumni Association Alumni Scholarship
5/31– Reunions: Classes of 1958, 1963, 6/3 1968, 1973, 1978, 1983, and the Thomas Jefferson Society 8–10 Reunions: Classes of 1988, 1993, 1998, 2003, 2009, and 2013
Fall semester begins
Nursing History Forum: “Fever of War: The Influenza Epidemic in the U.S. Army During WWI,” with Carol Byerly
28–29 Advisory Board and Alumni Council fall meetings
OCTOBER 13 16
Homecomings: Nursing Alumni Celebration
A PATH FORWARD 8 NOVEMBER 1–4
Virginia Film Festival
Nursing History Forum: “Historical Research and the 1918 Influenza Pandemic,” with Arlene Keeling
7–10 Train-the-Trainer Faculty Development Program conference, UVA’s Center for ASPIRE
President Ryan’s Inauguration
26–28 UVA Family Weekend
End of fall semester examinations