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The Healing Power of Technology: Nursing Students Spread the Word about UA College of Nursing Telehealth Research

Dec. 12, 2017
Jason Gelt

In early October, four students from the Doctor of Nursing Practice (DNP) program at the University of Arizona College of Nursing presented their research posters at the third annual Telemedicine & Telehealth Service Providers Showcase in Phoenix. Hosted by the UA’s Arizona Telemedicine Program, the conference is focused on building partnerships to bring high-quality telehealth services directly into hospitals, clinics, private practices and patients’ homes.

Kimberly Denise Shea , PhD, RN, CHPN

Nearly 400 attendees browsed an array of telehealth specialty services and supporting technologies and discussed the latest trends in applications of clinical telehealth. Associate Clinical Professor, Dr. Kimberly Shea, PhD, RN, CHPN, who accompanied the students to the showcase and serves as their doctoral committee chair, said, “It’s a national convention, and people come from all over the country. It’s a great way to give students terrific experience and shine a spotlight on the impressive work that students are doing in our doctoral programs, in the field of nursing and health informatics in general and more specifically telehealth.” 

Melissa Koon, MSN, APRN, FNP-BC, NP-C, third-year Dual-Degree DNP/PhD student
Project: A Best Practice Assessment Protocol for Mobile Technology Home

Tell us about your telehealth project.

We realized that technology could enable us to see more people in the home – especially those living in rural areas – than we could in person, so we’re working on bringing telehealth to palliative and hospice patients. The goal is to use telehealth to help people avoid having to go to hospitals or clinics. Typically, if you are a patient in hospice and need access to care, generally for distressing symptoms, you contact on-call staff and it may take a nurse an hour or two to arrive at your door. Using a telehealth strategy (an iPad for example) for the initial call, a nurse can immediately see what’s going on and coach toward a start on treatment or completely treat the distress. We asked our panel of experts, the hospice staff at Casa De La Luz, to help us develop a protocol by rating the most important activities occurring during home visits. We used the information to make the iPad visit protocol closely resemble the home visit, making sure the visits are appropriately structured and make good use of a limited amount of time.

How will your project impact patient care and education?

Compared to the usual approach, we expect that this telehealth enhancement will lead to relieving symptoms in a more timely fashion. It will also avert nurse burnout by allowing nurse case managers more flexibility in time management. In the realm of education, we hope to guide future nurses in how to do assessments and physical examinations by tablet visualization versus in-person, but still convey that personal human touch that comes with a visit. We’re already using telehealth strategies for many aspects of healthcare delivery, but not yet hospice and palliative care. We need to make this a formal part of our education programs because this is the way of the future.

John Lee Conway, RN, MSN, Ed., third-year online Dual Degree Doctor of Nursing Practice student.
Project: Telemonitoring: Utilizing Persuasive Technology to Improve Client Engagement

Tell us about your telehealth project.

I have a very personal interest in this field because it was the process of telemonitoring that identified anomalies in my mom’s heartbeat and led to early cardiac surgery. She was in and out of the hospital in record time and sent home with monitoring equipment.  However, she didn’t use it all appropriately. That led me to the question: What enablers would most motivate patients to monitor themselves and regularly report accurate healthcare data to their healthcare providers? The answer, I believe, lies in persuasive technology. My intention is to study the use of computers to test what would persuade patients to provide information to their healthcare providers on a regular basis. Improved, consistent and accurate health-related communication between the patient and provider would improve health and well-being outcomes and could be implemented at a distance. 

How are you helping to build better futures with your research?

My project is meant to expand healthcare capacity for managing chronic health care issues in the home, so the growing patient population of people with chronic conditions can be managed without repeat visits to hospitals or urgent care.  By managing health care using online strategies, we’re changing the face of how patient care occurs.

(L-R) Brooke Finley and Dr. Kimberly SheaBrooke Finley, BSN, RN-BC, third-year Dual Degree Doctor of Nursing Practice/ PhD student.
Project: Opting In: Exploring Veterans’ Satisfaction and Perceptions of Telecardiology

Tell us about your telehealth project

It started with my interest in using information technology like teleconferencing to transmit video or auditory signals between people. I was working for the VA as a cardiology research assistant while I was in nursing school and one of our cardiologists was really curious as to how patients were doing in their telemedicine clinics. So I designed this study when I was entering my PhD program to examine the satisfaction ratings of veterans using telecardiology versus those who came into the VA in person. The first part of my survey asked, ‘Would you recommend telecardiology to a friend or family member?’ and overall the veterans thought it was great: they would recommend it, they got really good care, and they could see the same provider team every time. Most of the time, they saved hundreds of miles driving.

What makes your project unique and innovative?

Telehealth has been around for a while, but there really hasn’t been a lot of superb research on it as a healthcare delivery modality. A lot of the studies do not include advanced methodology or well-controlled quantitative investigation. My intent is to design better quality studies in telehealth to provide evidence that telehealth use should be expanded. It can save a lot of money and it helps the providers have a better quality of life too, because they’re not commuting all the time. I believe that’s really a win-win for lots of people and is cost effective.

John Paulo Batucan Bautista, BSN, RN, AGACNP, third-year online Doctor of Nursing Practice student
Project: TeleICU Nurse-Directed Low Tidal Volume Ventilator Rounds

Tell us about your telehealth project.

I work for Banner’s TeleICU, whereby a central command station is linked to a number of intensive care units (ICUs) across Banner hospitals and we provide extra oversight and expertise to support the on-site staff. As part of quality assurance for patients using a mechanical ventilator to assist with breathing, we regularly examine reports of best practices for low tidal volume ventilation, which in seriously ill patients protects against the developing or worsening lung tissue injury.  When I looked at a series of quarterly reports of data across ICUs, I noticed that we were not consistently hitting the ideal benchmarks.  The use of this protective ventilation technique requires advanced knowledge of ventilator management.  My intent was to create a way using TeleICU technology to make sure every patient in every ICU gets the exact same quality of care. 

What makes this project particularly unique and innovative?

I’m using telehealth technology to remotely monitor patients in ways to help free up bedside nurses so they don’t have to worry about making sure that patients are on proper low tidal volume ventilation.

Student Spotlight: D. Anthony Tolentino

Dec. 5, 2017
Jason Gelt

D. Anthony Tolentino

Second-year PhD student; from California

Why did you decide to pursue a nursing degree?

I envy nurses that knew from the start that they wanted to be a nurse through some life experiences, a calling or an epiphany. My story is a bit odd as I was going to school to be a clinical lab scientist, but during the last semester of my first year I suddenly decided to switch to nursing. Ultimately, pursuing a career in nursing has been one of the best accidental decisions in my life. After being a nurse for 11 years, I have grown to fully appreciate what we do, the contributions we make, the love, dedication, and passion we bring daily despite the challenges, and the difference we make to our patients, families, communities and to each other. 

What drew you to the UA College of Nursing?

Drs. Sheila Gephart and Jane Carrington's area of research drew me to the college and the school's substantive area in Informatics. When I started searching for PhD schools, I wanted a curriculum that not only offered me the opportunity to learn about nursing science, but also had a substantive focus in informatics. After reviewing the biographies of both Drs. Gephart and Carrington, I knew I had to learn from them. In addition, the very accomplished faculty members with diverse expertise in research and practice, a highly-ranked nursing program, and research opportunities sealed the deal. Plus, the flexibility and rigor of the program drew me to apply at UA.

Tell us what it is about nursing informatics that you find so appealing?

Nursing informatics gives me the opportunity to make a difference in our patients' lives indirectly by implementing, supporting, and optimizing multifaceted health technology activities related to patient care.  The utilization of nursing science, computer science and information science to manage data and transform it to knowledge and to support nurses and other clinicians makes this specialty very appealing to me. The fact that informatics has a multiplier effect, that is, whatever I do as an informaticist can touch not just one patient, but many patients is very powerful. I can advocate for patients in a different level and contribute to the growing profession of healthcare informatics.  

What features of your program are you especially passionate about?

I appreciate the dedication of the faculty and administration knowing that they are genuine in seeing us succeed as future nurse scientists. When the program director, Dr. Anne Rosenfeld, knows each PhD student by name, that signals that she and the rest of UA staff are here for good reasons and are dedicated to nurturing the students to be the best nurse scientists. I am also very excited to learn from the best informaticians. As a working nurse informaticist who is not formally trained, I'm able to bring what I'm learning to my organization. In fact, I'm in the inaugural Nursing Research Fellowship at Dignity Health, and a big part of being selected is due to being a PhD student at the UA CON. 

Share your favorite memory from your time at the CON.

It's only been a year, but I already have many great memories at the CON -- ranging from forming strong and lasting bonds with my cohort and being a research assistant for Dr. Gephart, to going to conferences to present, network or connect. My favorite memory so far is volunteering at American Medical Informatics Association (AMIA) conference in Chicago last November, and winning the AMIA #Why Informatics video contest where I had the opportunity to showcase why Informatics can be boundless and can redefine the possible and the impossible.  The prize? I get to attend the conference in Washington, DC this November - for free! 

How do you intend to Build Better Futures?

Dr. Rosenfeld once asked us how we see ourselves in the future as nurse scientists. She asked us to think big and be boundless. This made me think why I pursued a PhD. I see my journey as a future nurse scientist as an opportunity to be a caregiver and a researcher to improve health outcomes. We are all in healthcare and nursing for a reason. Although my research focus is in technology, I still believe in the power of human touch. As nurses, we have the opportunity to be with our patients in their most vulnerable times. Technology may be gradually taking over our lives, and it may seem that the more we get connected the more we lose the human connection. To build a better future, I would like to find the appropriate balance of the use of technology with patient care. My vision is a future where we can provide high tech care with a human touch. The ultimate goal is to make it easy for our nurses to do the right thing for our patients. 

Are you funded by a scholarship?

I'm a recipient of the Nursing Scholarship Endowment for this year from the College of Nursing. I also work as a graduate research assistant for Dr. Gephart's NEC-Zero Project. 

There's a Mobile App For That! Enhancing Prospective Memory Through Technology

Dec. 4, 2017

Taking one’s medications as they were prescribed is essential to managing disease but sometimes a challenge in adults undergoing age-related or other kinds of memory changes.  Using theory and evidence specifically about prospective memory (remembering to do something you intend to do), University of Arizona College of Nursing Professor, Dr. Kathie Insel, is striving to assure that older adults are helped to take their medications as prescribed.  Having learned that cognitive functions called executive function and working memory (associated with successful prospective memory) also affect remembering to take medications, in prior work, Dr. Insel tested the behavioral intervention designed to support prospective memory and improve remembering to take medications. Applying the results of her prior research, which has been years in development, she and her team are now debuting a mobile app that could have wide-reaching implications for helping older adults in general and others who experience certain brain changes as a consequence of illness and/or treatment, e.g., treatment with chemotherapy sometimes referred to as “chemo brain”.

Dr. Insel and her colleagues, Dr. Jeannie Lee from the UA College of Pharmacy, Drs. Wendy Rogers and Dan Morrow from the University of Illinois, Dr. Gil Einstein of Furman University and Dr. Tracy Mitzner of Georgia Institute of Technology, are working with local Tucson company Ephibian to design and execute an app for smartphones that translates the essence of Dr. Insel’s behavioral intervention into consistent daily reminder support and more. The overall intent is to make self-management of chronic conditions easier and more successful, thus promoting continued independent living for as long as possible among older adults.

Kathleen C Insel , PhD, RN

“In the world of cognitive psychology, study after study has demonstrated differences between younger and older people and the way they process information and remember” says Dr. Insel, pointing to the two types of memory, retrospective memory (remembering something you did) and prospective memory (remembering to do something you intend to do). “My work is addressed to new terrain. To date, little attention has been focused on translating what is known about prospective memory into specific supportive strategies that can be put in the hands of patients and  therefore enhance older adults’ capacity for self-management.”

Now, thanks to a $275,000 National Institute of Health (NIH) R21 research grant, Dr. Insel and her colleagues will transform the behavioral intervention to a smartphone application (app) and test its influence on medication-taking by patients grappling with high blood pressure. “People think older adults don’t use smartphones, but there’s a generational change going on whereby older adults are more tech savvy than ever before. Furthermore, we are seeing that people are looking for apps to help with remembering to take medications. So there’s definitely a need.”

Evidence shows that as few as 50% of patients take medications as prescribed and the picture is worse when people are managing long-term illnesses such as high blood pressure as compared to short-lived illnesses such as a time-limited infection.  Dr. Insel’s multi-disciplinary team has designed their MEDSReM (Medication Education, Decision Support, Reminding and Monitoring System) to have all the features the name implies. Dr. Jeannie Lee as pharmacist expert is instrumental in guiding the medication decision support, such as what to do if you forgot to take it when you intended to take it.

“This technology is a promotion of health as well as a treatment of illness,” says Dr. Insel. “The current effort is focused on those with hypertension. Uncontrolled high blood pressure is the primary cause of stroke and a cause of heart disease, retinal and kidney damage hence taking medication as intended is important. We can make a huge impact in helping people effortlessly manage their condition, stay healthier and live independently longer.”

Ambassador of Integrative Health: Dr. Deborah Williams Weaves Integrative Care Techniques into Local Assisted Living Facility

Nov. 30, 2017
Jason Gelt

Her experience as a fellow in the University of Arizona College of Nursing’s inaugural 2016-2017 Integrative Nursing Faculty Fellowship (INFF), has uniquely positioned faculty member Deborah Williams, PhD, MPH, RN, to advance the College’s commitment to the science, theory and practice of integrative health. As the liaison between the College of Nursing and The Hacienda at the River, the latest assisted living community in the Watermark Retirement group, she has helped incorporate various integrative health interventions into the community’s care, including yoga, massage therapy, meditation, aromatherapy, reflexology, healing touch, acupressure and acupuncture. Under Dr. Williams’ supervision, the partnership between the College and The Hacienda creates a unique environment where nurse faculty can practice and nurse students can learn person-centered and relationship-based care that inspires optimal health and wellbeing.

The Hacienda at the River

What did you learn from the INFF?

The INFF taught me that it is acceptable to teach these integrative interventions to nursing students. To be brave and introduce new ideas in the classroom and in the clinical setting. In our fast-paced society, we need to care for people in a way that allows nurses to have the time to really listen to them and find out what works for them. People respond differently and we can advocate for their chosen interventions. Integrative nursing is a process which is centered on the person and the relationship we create with each other. The impact on health outcomes and wellbeing is remarkable.

What changes have you seen in students since you incorporated these techniques into your teaching?

Recently, I heard from a graduate who told me about a job interview she had at a hospital. She wanted to say thank you because in her interview she talked about how she had learned the integrative nursing approach that I introduced in the medical/surgical and psychiatric mental health clinical rotations. She felt like that knowledge set her apart from the other candidates and she ended up getting the job. When I began teaching the integrative approach to managing symptoms, I started to see students thinking beyond prescribed medications and offering things like guided imagery and breathing techniques instead of Tylenol. And interestingly, their care plans started to reflect these interventions, choosing less invasive treatments.

Tell us more about the integrative techniques you’ve incorporated into your work?

Each fellow chose two modalities to focus on and I chose relaxation response and music. Music does wonders. At The Hacienda, I see its effectiveness in terms of behavior changes and happiness in assisted living and memory care residents. I have been writing policies and protocols for many of the integrative interventions. Our administrative team starts the day together with Qi Gong, a meditative quote, or centering. I am in the process of bringing to The Hacienda integrative practitioners from the community for a full repertoire of integrative services.  

One of the six principles of integrative care focuses on the health and wellbeing of caregivers as well as those they serve. What is particularly important about self-care for nurses?

In nursing you are used to taking care of other people. I remember very well being a nursing student. There was no down time. You have academic work you need to do and on top of it you are in clinical, taking care of people and learning and then you are going back to the books again, reading about what it was you saw in practice. It’s this constant back and forth and it’s easy to forget to take care of yourself, but if you are not in top form it is hard to fully focus on the needs of your patients. In clinical post conferences sometimes I have my students do a brief meditation or I’d ask them about their weekend plans, and I would encourage the students to take time -- even if it’s just an hour – to give themselves a break. And then I would check back with them and find out what they did as a way of keeping them accountable.

Tell us about some of the other integrative health activities you supervise at The Hacienda.

We have a Zen Down hour every day of the week. Every day focuses on a different topic such as mindfulness, gratitude, and wellbeing. Recently, I introduced mindfulness and we had an engaging 45-minute conversation. We used clementines in an exercise. It was all about being mindful, so we talked about the texture, the flavor, being present in the moment – it was just a really neat conversation and exercise together. That probably is my greatest challenge right now in training caregivers: You’ve got to become comfortable and not afraid to try new things.

UA Nursing Investigates Unique Solution to Preventing the Health-Related Downsides of Immobility

Nov. 27, 2017
Jason Gelt

“Long periods of immobility have ravaging effects on your body,” says University of Arizona College of Nursing Clinical Associate Professor Laura McRee, DNP, ACNP-BC, LMT, RNFA. People who are confined to bed rest or who have other mobility limitations are prone to an array of adverse reactions, including rapid reduction of muscle mass and bone density that decreases a patient’s muscle strength over time. One of the direct consequences can be deep vein thrombosis (DVT), which creates a risk of pulmonary embolism, a condition that is responsible for 60,000-100,000 deaths in the United States each year. Currently, the only treatments available to treat DVT in health-care settings are anti-coagulant injections with potentially serious side effects or expensive sequential compression devices.

McRee, who has focused the bulk of her research on preventing such conditions, may hold the keys to a better way with her new invention, the Bed-Sled. The innovative resistance training device promotes movement for a patient’s lower legs using a spring-loaded footpad to create resistance, thereby preventing muscle de-conditioning and the formation of blood clots. Equipped with a sensor to record the amount of pressure applied and the number of depressions of the footpad, the Bed-Sled tracks the progress of a patient’s lower extremity strength.

Laura McRee, DNP, ACNP-BC LMT,RNFADesigned to be both portable and affordable, McRee’s device currently exists in a small-scale prototype format, but plans are underway with the help of Tech Launch Arizona and their National Science Foundation Innovation Corps (NSF I-Corps) Site Program to create a full-size version that can undergo clinical testing. “We have found nothing like it available in the marketplace right now,” says McRee, who has already filed for a provisional non-provisional utility patent. “This isn’t strictly for institutionalized use. It can be used for anybody in the commercial market. The electronic part is basic, the set-up is easy and because of that it will be cost-effective."

McRee’s invention could ultimately save billions of dollars through use in hospitals for physical therapy, but the average consumer stands to benefit as well. Thanks to her participation in the current NSF I-Corps cohort, she is gaining the expertise to expand commercial possibilities for the Bed-Sled and to target a broader base of customers. “Bed-Sled has the potential to appeal to a global market,” says McRee, pointing out that accessibility and ease of use can benefit anybody in an immobile state, young or old. “Sometimes, it doesn’t have to be a complex change that makes a profound difference to prevent adverse consequences and promote health.”

Code Lavender: Mary O’Connell Ushers Integrative Health Therapies into the Classroom

Nov. 13, 2017
Jason Gelt

As a fellow in the University of Arizona College of Nursing’s inaugural 2016-2017 Integrative Nursing Faculty Fellowship (INFF), faculty member Mary O’Connell, MA, RN, PHN, has enthusiastically incorporated elements of the science, theory and practice of integrative health into her classroom curriculum. In September, fulfilling the Fellowship’s mission to help nurse-educators creatively and effectively incorporate integrative nursing into education programs, O’Connell launched a new classroom mindfulness initiative called Code Lavender. Designed for the BSN senior students to personally experience integrative health techniques, she helps them engage in different integrative therapies as a form of self-care and to learn potential ways to help the patients for whom they care.

What did you learn from the INFF?

The experience opened my eyes to the different therapies that we can apply as a compliment to the usual therapies not only for our patients but also for our students and their own self-care and wellbeing. As fellows, we were asked to explore a therapy or two in depth on our own, and I chose to delve into acupressure and acupuncture as well as some aromatherapy. While I might not yet be skilled in acupressure or acupuncture, I am able to help people know about them and can appropriately recommend when they can be tried.

What was the biggest takeaway from your experience?

That you should always start with the least intensive modality and build from there. For example, if I had a patient in pain, rather than getting the oxycodone, I would probably begin with some visualization, a mindfulness technique intended to help realize centering, calmness and wellbeing and assess the effects. This might reduce the need for strong painkillers – and help alleviate the public health problem we have with opioid addictions.  I’m also a big believer in another principle of integrative nursing: the healing powers of nature. For example, making sure that patients get outdoors and exposed to natural light have a powerful effect on relieving negative mood and mental decline. For me, helping students learn the core six integrative principles and translate them into nursing healing approaches is very gratifying.

How did Code Lavender come to be?

Within my INFF cohort, one of our projects was to develop our own curriculum change that would educate students about aspects of integrative nursing. Often in health care, when a code is called, it is in response to a need (e.g., adverse event). Code Lavender was designed as a call to action for students to treat themselves and others, using compassionate, healing acts. So far, we’ve done a Code Lavender with mindfulness and an aromatherapy activity as ways to alleviate stress before exams. I have asked students to conduct their own version of an individual Code Lavender exercise with another student in their cohort.

Tell us more about changes to the classroom experience.

All students keep a self-care journal over the span of eight weeks. They interface with a buddy each week about how things are going so they can support each other. Based on their interests, students may also choose to create something visual that’s a powerful reminder of personal wellness for them, present it and then provide a write-up concerning their choices of the medium. For quieter students who may not like getting up in front of a group, they have chosen to do gratitude journaling over the period of a month, with an evaluation at the end.

What are your hopes for bringing integrative nursing and health to the fore in future teaching?

I plan to continue to expose students to learning the integrative principles, and applying them both inside the classroom and when caring for patients. One of the things I’ve done during their clinical rotations is give them an assignment when they’re out there in practice, doing three twelve-hour shifts each week for a five-week period. During that time, they really get a taste of what it’s like to be a registered nurse handling a whole team of patients. Each student carries a laminated card printed with the six integrative nursing principles, and then in a weekly journal reflects on the question, ‘What integrative nursing principle did I apply on behalf of my patients this week?’ Therefore, rather than just preaching about these different therapies, students embed integrative care principles and actions into their clinical practice. It’s a way to continue the work launched in 2014 by my faculty colleague, Dr. Mary Koithan and University of Minnesota faculty member, Dr. Mary Jo Kreitzer with their landmark Integrative Nursing guide. My long-term hope is that UA nurse graduates, after becoming registered nurses, will continue to learn about integrative nursing and health and to enrich their care for themselves and their patients by applying their integrative health knowledge and skills throughout their careers.

Jason Gelt
jasongelt@email.arizona.edu
520-626-2742

Nursing Alumna and Faculty Member Take to the Skies to Aid Patients in Baja, Mexico

Nov. 6, 2017
Jason Gelt

Established to bring essential medical and dental care to remote El Rosario, Mexico, the Tucson Chapter of Flying Samaritans Arizona is an all-volunteer organization dedicated to improving the health and wellbeing of patients in high need. Once a month (except during monsoon season), the group takes to the skies in small passenger planes loaded with a cargo of medical supplies and health care providers – nurse practitioners, physicians, dentists, hygienists and nurses – to provide supplemental health care for a local population. The University of Arizona College of Nursing faculty, Dr. Patricia Daly, started volunteering in 2012, and in 2014 became the organization’s medical director.

With her emergency room expertise, Dr. Daly was a perfect choice for the job. In addition to helping people in need, she sees it as an opportunity to enable clinical caregivers to have the experience of delivering care in areas where technology is minimal. “You learn to improvise. It’s critical for the people of El Rosario,” she says. “And it’s enriching for your practice to have that trans-cultural experience. Delivering care without access to usual technology hones your innate physical examination and diagnostic skills. Likewise, limited therapeutics resources make you adapt and invent novel treatments using only available resources.” In the future, Dr. Daly hopes to develop ways for College of Nursing students to participate in the program as part of their clinical learning. Last month Dr. Daly brought along Janay Young, a May 2017 Doctor of Nursing Practice (DNP) program graduate. “She caught on in a flash,” Dr. Daly says of Young. “Having her there doubled the number of patients who could be seen.”

Always interested in the achievements and adventures of our alumni, we caught up with Janay recently to get her thoughts on being with the Flying Samaritans.

Have you participated in anything like this before?

Years ago I was fortunate enough to participate in an international medical outreach to El Salvador as a nurse, so I had an idea of what to expect. I was aware of the differences between the health systems of the U.S. and South America and tried to be as flexible and open as possible. My previous experience with a big organization was very coordinated. We had an itinerary that was carved in stone. But with the Flying Samaritans, we definitely had to be more nimble at adjusting to circumstances. I really appreciated this different kind of experience.

What was the trip like?

We flew out of Ryan Airfield on a Friday morning and landed in Nogales to pick up three other volunteers, a dentist and two fluent Spanish speakers who planned to help with translating and triaging at the clinic. When we got to the airport in Mexico we met with the rest of the group who had also flown over in smaller planes and then we drove to the clinic. We worked Friday afternoon and all day Saturday and then flew back on Sunday. It was definitely a whirlwind experience: busy but gratifying.

What kind of care did you provide?

The Flying Samaritan organization has an agreement with Mexico that providers licensed in the United States may provide equivocal care in Mexico.  Many of the patients that sought care were farm workers or laborers, so a lot of what we saw was what you would anticipate would be trouble for really hard-working people: sore joints or musculoskeletal injuries. One of the cases that stands out to me was a woman who was not able to get regular treatment for depression. She said she had had ongoing depression for several years, had been able to take medication at one time but was no longer on it, and her depressive symptoms were returning. In talking further with her, I learned that she had a non-verbal 10-year-old son and she had to manage his special needs with no local or affordable services. In the States, people with intellectual disabilities get hooked into services quickly regardless of socio-economic status, so it was sad to realize there wasn’t much that I could do on that one day to help. Dr. Daly calls it Wilderness Medicine in the sense that we can’t follow up with patients long-term because different providers come every month, and weather can sometimes cancel trips. It was very much, ‘What can we do today,’ so for that particular patient I talked about some stress management techniques and I was able to give her some supplements and melatonin to help with her sleep issues.

What did you learn from this experience?

It’s so humbling that these individuals came and waited for services all day for hours. I did my best to listen and try to communicate with my limited Spanish. Even with the finite skills and resources I had available, people were still grateful for and receptive to them.

Going forward, how will this experience inform your approach to nursing?

You can’t just sit down and say, ‘Okay, tell me what’s going on and ignore context.’ You really have to take some time to establish a rapport. I’ve been a nurse for a while so I had that sense already, but this experience definitely reinforced the importance of taking the time to ascertain where somebody is coming from within the uniqueness of their culture or environment, taking the time to listen and gain their trust. This is essential to making a difference in whether they are likely to follow your suggested therapies.

Jason Gelt
jasongelt@email.arizona.edu
520-626-2742

UA College of Nursing Professor Uses Chair Yoga to Help Older Adults Increase Mobility

Oct. 31, 2017
Jason Gelt

For people having trouble with their bodies cooperating with their desire to engage in regular, low-impact exercise like yoga, chair yoga may be a wise solution. A gentle form of yoga, chair yoga is ideal for people unable to engage in traditional yoga classes due to the effects of aging or disabilities. For that reason, it was one of the first integrative health modalities to be launched at The Hacienda at the River, the latest senior residential community initiated by the Watermark Retirement group.

“It’s a truly adaptable health therapy,” says Dr. Leah Stauber, University of Arizona College of Nursing faculty member, who teaches The Hacienda’s weekly chair yoga class. “You don’t need to be in any particular space, you don’t need any props or even an instructor once you’ve had some practice. Since many of the guests at The Hacienda rely on a cane or a wheelchair to be mobile, the beauty is it’s accessibility because it cane be performed anywhere, anyplace, anytime.” Among several benefits, evidence indicates positive effects on breathing, range of motion and mood/mental state.

Leah S. Stauber, PhD, Clinical Assistant Professor

Dr. Stauber, with her more than 10 years of experience in teaching chair yoga, has also taught traditional yoga to high school students, social workers, expectant and new mothers, nurses, memory care patients and professional athletes. On a recent Thursday morning, six Hacienda residents gathered in a peaceful, inviting sunlit living room, surrounded by leather-bound books, plants and comfortable furniture.  to participate in Dr. Stauber’s class. Following Dr. Stauber’s class, residents commented on appreciating the opportunity for exercise as well as the social pleasure of engaging with a group.

With a focus on independent living, assisted living and memory care communities, The Hacienda residents are helped to advance their personal wellbeing in ways that are physical, spiritual and emotional. For example, aromatherapy, reflexology, acupressure and acupuncture have been woven into care, but the special value of chair yoga is that it is active and helps residents accustomed to a sedentary existence to become more mobile. Dr. Stauber points to the fact that The Hacienda’s caregivers also have attended her class to learn stretches and therapeutic movements they can then do one-on-one with their family or loved one.

The integrative health and well-being is a focus for the special partnership between The Hacienda and the UA College of Nursing, with its integrative health focus and one-of-a-kind Integrative Nursing Faculty Fellowship (INFF). “The College of Nursing Integrative nursing faculty fellows are advancing best practices for educating nurses and nurse educators in the art and science of integrative health and well-being,” says Dr. Stauber. “The goal is to teach them to implement various modalities as well as the principles of integrative nursing itself, and bring them together in a sustainable way. It’s a teach-the-teacher model.”

“Yoga helps return us to the ways in which our bodies worked at healthier points in our lives,” Stauber says. “The movements bring our bodies back into a fuller range of motion, one closer to when we were young. Most importantly, it helps remind us of the ways in which we breathed, before we started sitting at desks, for example, before everything got compressed in the chest, and our breath became really shallow. Shallow breathing is known to have many adverse effects on our bodies, including on blood flow, various hormones and the central nervous system.”

Jason Gelt
jasongelt@email.arizona.edu
520-626-2742

Student Spotlight: Kaliandra Coenen

Oct. 27, 2017
Jason Gelt

Kaliandra Coenen

Third-semester senior in the bachelor of science in nursing (BSN) program; from Tucson, AZ

Why did you decide to pursue a nursing degree?

My interest in nursing was first cultivated during high school, when I learned what a rewarding career nursing could be. I have always had a passion to serve others and have done so through volunteer service and previous work experiences; however, I strongly desired to serve at a greater capacity.  Nursing provides the opportunity fulfill this passion while challenging me daily to grow in knowledge and skill to care for patients. After high school, I started a family and my dream to become a nurse was put on hold. During this time, life experiences including the birth of my three children and helping to care for my grandfather further showed me the great impact that a nurse can have on a person’s health care experience. I want to become a nurse because I want to provide compassion, advocacy and positivity to patients and families in some of their most difficult times.

What drew you to the UA College of Nursing?

I believe that nursing education is crucial to providing excellent care. During my search for nursing programs, the University of Arizona stood out to me as a school that strives to shape exceptional nurses.  I value the college’s emphasis on teaching nurses to utilize research in their practice, as I feel that it provides understanding and support for nursing care. I was also drawn to the colleges support and encouragement during my search for schools. I recognized that the program ahead would be challenging, but I was welcomed, even during the stressful time of nursing school applications, with great support from the College of Nursing.

What features of your program are you especially passionate about?

Within the College of Nursing, there is an emphasis on caring for the patient as a whole person and not just treating the medical condition. The program teaches students to support patients socially, emotionally, and physically. I love that the College of Nursing also provides excellent opportunities to learn how to support and care for people in some of the most difficult times of their lives. The instructors have brought in many members of the community to share their personal health experiences, including living with a disability to experiencing loss of a loved one. This has allowed me to have a greater perspective on how to listen to the patient and care for the individual.

Share your favorite memory from your time at the CON.

My favorite memory in the College of Nursing was the last simulation day of second semester in which a team of my classmates and I cared for a patient in the lab. We had been working together all semester in clinical and lab and had really learned how to work as a unit. During this stimulation, we complimented each other, which allowed us to provide exceptional care for the patient. During this moment, I recognized the full value of working with an excellent team of health-care providers.

How do you intend to Build Better Futures?

I believe that education can make a strong impact on the community’s health; thus, I intend to become active in the community and promote health through providing culturally appropriate education and resources. I also strongly believe that it is important for nurses to continue learning and following current research to be able to implement it in their practice. I personally desire to continue my education, so that I may become a more effective nurse to provide exceptional care to my patients.

Medicare Graduate Nurse Education Demonstration Increases Primary Care Workforce

Oct. 25, 2017
Jason Gelt

The number of advanced practice registered nurse students and graduates increased under the Centers for Medicare & Medicaid Services’ Graduate Nurse Education demonstration project, according to a new report to Congress by the Department of Health and Human Services. “The GNE demonstration had a positive impact on APRN growth, and helped transform clinical education within participating GNE schools of nursing,” the evaluation report concludes.

The Affordable Care Act authorized the Medicare demonstration to test whether paying eligible hospitals to help offset the costs of clinical training for APRN students could help increase the nation’s primary care workforce. In 2012, CMS selected five hospitals affiliated with 19 university schools of nursing (including the University of Arizona College of Nursing) and hundreds of community clinical partners and collaborating health systems to participate in the program: Duke University Hospital in Durham, NC; Hospital of the University of Pennsylvania in Philadelphia; Memorial Hermann-Texas Medical Center in Houston; Rush University Medical Center in Chicago; and HonorHealth Scottsdale (AZ) Osborn Medical Center. The AHA’s American Organization of Nurse Executives subsidiary played a significant role in developing the original concept for the demonstration.

Jason Gelt
jasongelt@email.arizona.edu
520-626-2742