While social media can provide connections with others, social isolation removes people from nature and the outdoors. People who cannot go outdoors may experience increased stress and anxiety as a result.  Although technologies exist to provide immersive experiences (e.g., virtual reality), they require specialized equipment and are expensive. The vast majority of Americans across age, race/ethnicity, and socioeconomic status own smartphones; and of those, most use mobile apps. Dr. Gordon’s project addresses this stress by offering a mobile app that delivers a Guided Imagery intervention.

Guided imagery is a proven method that uses enhanced visualization to help people deal with stressful situations, including social isolation. More than just visual images, guided Imagery involves imagining sights, sounds, tastes, smells, tactile senses, and the emotions you feel in a particular situation. Dr. Gordon and her colleagues have used Guided Imagery successfully to help people make positive lifestyle changes, like quitting smoking, eating healthfully, and getting more exercise. Guided Imagery also has been shown to be effective at reducing chronic pain and anxiety.

"Using a simple mHealth app to deliver Guided Imagery audio files will provide endless possibilities for simulating outdoor experiences for the millions of Americans experiencing social isolation," ~ Judith Gordon, PhD, UArizona Nursing Associate Dean, Research

“Using a simple mHealth app to deliver Guided Imagery audio files will provide endless possibilities for simulating outdoor experiences for the millions of Americans experiencing social isolation,” Dr. Gordon said.

The See Me Serene app provides users with immersive, vivid, nature experiences designed to reduce stress and anxiety related to social isolation. The app will be a more affordable and scalable solution than Virtual Reality, which requires expensive and specialized equipment. “See Me Serene allows users to select from at least 50 different audio files, each describing a different outdoor experience. The app also contains links to mental health resources that are available 24/7,” Dr. Gordon said.

The goals of the See Me Serene research project are to pilot test the app with 100 participants. Participants will provide self-report survey data and will be tested for cortisol levels collected from saliva. Cortisol is a biological marker for stress. Participants will use the See Me Serene app for 4 weeks. People interested in participating can contact the research team from within the app.

“Our hope is that See Me Serene will be easy to use and that it will help people cope with the stress and anxiety they’re feeling as a result of being stuck indoors,” Dr. Gordon said. “If our pilot results are promising, we will seek funding to conduct a large-scale efficacy trial. In the meantime, the app will be free for anyone to use.” See Me Serene is available on the App Store and the Google Play Store.

The BIO5 grant was made possible with resources from the BIO5 Institute and the Technology and Research Initiative Fund (TRIF) to help researchers quickly pivot their work to address the pandemic in areas related to improving the health of Arizonans. 

The Technology and Research Initiative Fund that helped launch BIO5 in 2001 continues to be a catalyst in enabling effective, cross-disciplinary bioscience research and innovation at the University of Arizona, where initiatives and projects are carefully chosen to align with areas of state and national need.

Over the past 19 years of TRIF, over $50 million has been invested in building critical facilities and research services that UArizona is leveraging today to quickly and robustly respond to the current COVID-19 crisis. TRIF allows the flexibility to pivot and repurpose campus resources to engage in the complex fight against COVID-19, drawing on faculty expertise, campus facilities, logistical assets, research labs, and campus staff and leadership to provide immediate assistance in the battle against the pandemic.

The See Me Serene App is available from the App Store and Google Play. Find more information here. 

"After 30 years in Chicago, I desired to live in a smaller, more intimate community close to nature while continuing to thrive professionally at a research-intensive university. UArizona meets those criteria and I am thrilled to be here amongst stellar faculty at the College of Nursing," ~ Aleeca Bell, PhD, RN, CNM, R, UArizona Nursing Associate Professor 

What drew you to a career in nursing?

Giving birth to my son at home with a midwife in Northern California empowered my confidence as a new mother and planted the passion to become a midwife. Shortly thereafter, I initially learned midwifery through the apprentice model followed by an academic journey to become a certified nurse midwife.

What attracted you to the UArizona College of Nursing?

After 30 years in Chicago, I desired to live in a smaller, more intimate community close to nature while continuing to thrive professionally at a research-intensive university. UArizona meets those criteria and I am thrilled to be here amongst stellar faculty at the College of Nursing. The College’s biological laboratory is an exceptionally strong resource for faculty. Collaborators on the R01 include two faculty from UArizona’s Anthropology Department, and I have no doubt I will soon be collaborating with faculty in UArizona Nursing.

"As our new MEPN Program Director, Dr. Wilson brings a wealth of experience in teaching and developing courses and academic programs," ~ Connie Miller, DNP, RNC-OB, CNE, Clinical Associate Professor and Chair, General Nursing and Health Education Division

Dr. Wilson earned her BSN and MSN from Marymount University in Arlington, VA and completed her DNP from George Washington University in Washington, DC with a concentration in Nursing Administration.

Dr. Wilson has worked in nursing higher education continuously since 2009, teaching across education levels and programs including the BSN, CNL, MS and DNP programs. In her most recent position, Dr. Wilson functioned as an active faculty member teaching both in the live classroom (pre-COVID19) and online, directed the BSN Program, chaired the Undergraduate Educational Outcomes Committee, and provided guidance to the Student Nurses Association as Faculty Advisor. Several new initiatives were implemented in her short tenure that support student success.

Dr. Wilson has demonstrated strong leadership skills in such areas as undergraduate curriculum, advisement, mentoring and working with difficult student situations. She knows the importance of consultation with faculty members and fellow administrators related to resolution of difficult student circumstances, interpretation of test statistics for improvement, and implementation of best practices in clinical education. Suggestions made under her tenure at Georgetown University strengthened the curriculum and ensured the BSN Program met the BSN Essentials and CCNE accreditation standards.

Dr. Wilson has been a practicing nurse in a variety of staff/management positions for 35 years. Clinical nursing has always been an important part of her career since 1982. Until very recently she worked on a "PRN" basis as a Clinical Practice Specialist at the only Level I Trauma Center in Colombia, SC. Her practice included providing support and mentorship to new nurses; those with less than two years of clinical experience.

"The Arizona Nursing Inclusive Excellence (ANIE) program reduces barriers to undergraduate and graduate education for underrepresented students in the dominant cultures in Arizona: American Indian, Hispanic, rural, and border residents through an academic enrichment program that includes summer intensives, a writing skills improvement program, faculty and peer mentoring, and a student self-care and resiliency program." 

Penned by a UArizona Nursing faculty member and four faculty members from nursing schools participating in the Health Resources and Services Administration's Nursing Workforce Diversity grant initiative to promote holistic admissions review, the article describes the current state of workforce diversity in Western states and identifies promising practices. Titled “Nursing Workforce Diversity: Promising Educational Practices,” it describes promising practices from four innovative programs located in Arizona, California, Colorado, and Oregon that are focused on improving nursing workforce diversity. The authors, representing the Oregon Health & Science University School of Nursing, the Colorado Center for Nursing Excellence, California State University, Fullerton, School of Nursing and UArizona Nursing, share the ways each project has unique situations and approaches to improving admission, retention, and graduation of students underrepresented in nursing.

About UArizona’s ANIE program, the authors write, “the Arizona Nursing Inclusive Excellence (ANIE) program reduces barriers to undergraduate and graduate education for underrepresented students in the dominant cultures in Arizona: American Indian, Hispanic, rural, and border residents through an academic enrichment program that includes summer intensives, a writing skills improvement program, faculty and peer mentoring, and a student self-care and resiliency program.”

Similar approaches each project used include holistic admission review, academic and student support, financial support, and mentoring. The authors conclude that these projects contribute to knowledge development related to improving nursing workforce diversity for other colleges, universities, and states to consider. Improving nursing workforce diversity is a priority issue that could lead, through collective impact, to resolving health inequities nationally.

UArizona Nursing continues to take pride in being in the vanguard of academic institutions committed to inclusive excellence. Read more about the ANIE Program here.

"You can teach in another language and help people understand the basics of behavior change and how to intervene, particularly with cancer survivors.  This is really the first step in many more iterations of research that follow from this," ~ Tracy Crane, PhD

“Arizona is becoming known for doing these telephone-based interventions for cancer survivors,” says Dr. Crane, who was contacted by MEDEA coordinating investigator Ines Vaz Luis, MD, MSc, because of her involvement with Dana Farber Cancer Institute’s Be-Well program.  Dr. Crane is a consultant on the Institute’s 3,000-person weight loss trial for breast cancer survivors, which examines telephone-based intervention examining weight loss and the progression of disease – a program Dr. Luis hoped to replicate in France around issues of weight loss and fatigue in cancer survivors. “They called me because I had trained all of the coaches on the Be Well study,” says Dr. Crane. “They asked me to come over and collaborate on training the French coaches for the MEDEA study.”

Dr. Crane’s visit to Gustave Roussy, which is located in South Paris, was a whirlwind of activity. “I left Sunday, arrived Monday, got over jetlag and then Tuesday I started working,” she says. “I literally worked Tuesday to Friday. People asked, ‘Didn’t you love Paris?’ and I said, ‘I didn’t even see Paris. I was at the Cancer Center.”

Dr. Crane trained MEDEA staff in the in basics of nutrition, weight loss, motivational interviewing and behavior change. She also supervised the implementation of various corded role-playing phone calls where staff pretended to be patient participants and patient advocates to fine-tune the rhythms of the intervention. 

“I used a very similar protocol I’ve used for several studies,” says Dr. Crane. “You train people didactically, and then you put them into mock scenarios. After that, we listen to the call together, give feedback, and then we do another one.”

After the intensive training sessions, Dr. Crane says, her colleagues in the MEDEA program were ready to begin the project in earnest. “They had a little more follow-through practice to do after I left, but they’ll be ready to talk to actual participants,” she says. Thanks to her guidance, the program plans to enroll patients from all across France by April of this year. 

As for the future, Dr. Crane plans on future trans-continental journeys to assist further with the MEDEA program. Her work will benefit not only her colleagues in France, but render evidence for the efficacy of her research program in broader terms that will also benefit UArizona Nursing. In the long run, she is curious to see if the Be Well study can be replicated in another country and to gather more evidence supporting the necessity for these kinds of lifestyle interventions for cancer survivors.

“Right now, not everybody gets this,” says Dr Crane. “But should everybody be getting this? Do they have fewer readmissions? Do they have fewer illnesses? Fewer problems long-term? Toxicities that are a result of cancer? Are all of those impacted by this intervention? Because with answers to those questions, then we can begin to take that data and say, ‘Look, we need to offer some kind of program across the board.’”

In the meantime, Dr. Crane is proud of the outreach she’s done with the MEDEA program and hopeful that it will ultimately be implemented in larger ways that benefit even more cancer survivors and their informal caregivers. “The biggest takeaway is that people are motivated to make these changes,” she says. “You can teach in another language and help people understand the basics of behavior change and how to intervene, particularly with cancer survivors.  This is really the first step in many more iterations of research that follow from this.”

What is it like to be on the frontline of the COVID-19 pandemic?​

​I work in a cardiothoracic ICU that is also a combined ICU. When the pandemic hit, the hospital developed a COVID unit and all ICU staff floats to the COVID unit. In the beginning, it was scary for many different reasons. You wonder if you’re going to contract the virus and give it to my family, or do I have it already and am I going to give it to one of my patients? I remember after the first two shifts I had in the COVID unit, I went home to sleep and woke up with what I thought was a sore throat. After my life flashed in front of my eyes, I realized it wasn't a sore throat, but instead, my mouth was really dry. Two weeks into the pandemic, I got a call from my mom, who was in the hospital for an ongoing chronic issue. She was crying, saying she had the virus. She thought it was a death sentence for her. That was a challenging time for me. She has since tested negative, but the effects the virus had on her is long-lasting. I realize the individuals who don't take this virus seriously are those who have not seen what it can do to you, how you can walk into the hospital and be on a ventilator for 45 days. Or you can walk into the hospital, and the next time your family sees you is to say goodbye. If more people experienced what frontline workers experience, there would be more following the CDC guidelines to keep us all safe.

"I take pride in being a Wildcat Nurse. The UArizona nurse anesthesia faculty has been excellent and makes us all feel supported in a rigorous program," ~ James Gibson, UArizona Nursing DNP student

Can you share your perspective of the challenges nurse anesthetists face during this crisis?​

​I start my clinical training in December, so I do not know from firsthand experience yet. However, nurse anesthetists are the airway specialists. As members of the anesthesia team, we are at the head of the bed managing the patient's airway. We are responsible for intubation -- inserting a breathing tube in the airway -- suctioning secretions from their airway, and removing the breathing tube when indicated. All these procedures are high-risk aerosolizing procedures, which we know is the number one way this virus spreads through droplet particles. We are at an increased risk when managing the airway of a COVID-19 confirmed patient or non-infected patients where their virus status is unknown.

What is involved with your work in the COVID unit?​

​During my nights working in the COVID unit, I am usually assigned the sickest patient. Often, the patient will be on several continuous medication drips for sedation, pain, and two to three other medications to support the function of their heart and blood pressure. As the bedside nurse, I am responsible for titrating all these drips based on the patient's response. Many of these patients, at some point, suffer injuries to their kidneys and need bedside dialysis. Because they are too unstable to have dialysis, we place them on continuous renal replacement therapy, or slow continuous dialysis. So in all, we are responsible for continuously assessing the patient, administering other medications, managing the ventilator, managing the continuous renal replacement therapy, drawing blood work, collaborating with doctors and respiratory therapists, communicating with patient's family, bathing the patient, and through all that trying to follow stringent infection control practice not to catch the virus. Somewhere in there, we also have to deal with our fears, feelings, and mental health.

What does it mean to you to be a Wildcat Nurse?​

​I take pride in being a Wildcat Nurse. The UArizona nurse anesthesia faculty has been excellent and makes us all feel supported in a rigorous program. In a few years, when I am working as a nurse anesthetist, I will feel pride to say I obtained a doctoral degree from the University of Arizona.

What does the future hold for you?

I want to enjoy the fruits of my hard work and provide for my family. I want to work hard to become a great nurse anesthetist. I want to find a way to use my knowledge, life experience, and education to encourage more people to do the same. I want to create a legacy for my family. I want to use my platform to fight for social change in this country. I have my work cut out for me, but I will keep doing what needs to be done. I read from a nurse anesthetist online recently that you can't be what you can't see. Hopefully, accomplishing my dreams can motivate others who look like me to know they can do the same.

"I was part of an amazing multidisciplinary group who met and spoke almost daily to discuss best care practices as information came out daily. Using clear communication and discussion of risk/benefit, we were able to institute and change care recommendations," ~ Samantha Alessi, UArizona Nursing PhD student

Dr. Gephart is nationally recognized for her research into technical and parent-engaged solutions to reduce the burden of necrotizing enterocolitis (NEC) – a devastating disease that can infect the intestines of premature infants. Because of their coinciding research interests, it was immediately clear to Alessi that Dr. Gephart would be her ideal advisor. In April, as part of a team of nursing students at New York University Langone Health, Alessi published a paper in Current Problems in Pediatric and Adolescent Health Care, a monthly peer-reviewed medical review journal covering pediatric and adolescent medicine. Alessi and her peers were driven to examine the problem of COVID-19 in relation to neonatal care units in the New York City area.

The introduction to their paper states, “One of the most vulnerable pediatric patient populations is cared for in the neonatal intensive care unit. There is limited data on the effect of COVID-19 in fetal life and among neonates after birth. Therefore there is an urgent need for proactive preparation, and planning to combat COVID-19, as well as to safeguard patients, their families, and healthcare personnel.” The team’s ultimate aim was to consolidate recommendations from the Centers for Disease Control and Prevention (CDC) and local resources to provide basic guidance and checklists to clinicians in the neonatal intensive care units in key aspects of preparation needed to counter exposure or infection with COVID-19.

We caught up with Alessi recently, not only to welcome her to our Wildcat Nurse family but to learn more about the challenges she has faced as a nurse researcher in her efforts to help some of our most vulnerable citizens from the dangers of COVID-19.

Can you share your perspective on the challenges nurses and nurse researchers face during this crisis?

It has been hard going into work every day with so many unknowns. Not knowing when the crisis will end, will I bring it home to my family, how do I keep myself safe? The other piece that has been most challenging has been the influx of information and the rapid pace of changes in recommendations of care. New information was released daily, changing what care. On the flip side, the fluidity of the care teams, embracing the change and coming to work giving their all demonstrated how resilient nurses can be.

What was the inspiration for your study on neonatal intensive care preparedness?

I fell in love with the NICU after floating there when I was a Mother/Baby nurse. I love watching the babies grow and how resilient they are. Babies can do amazing things!

What particular vulnerabilities do neonatal nurses and patients face?

There are so many. I think neonates are vulnerable recently due to the unknown effects of COVID-19 on their population. Although vertical transmission has only been described in case reports to date, we do not know the ramifications of being in utero when a mother has been critically ill.

Can you describe the need for the guidelines you have developed?

I was part of an amazing multidisciplinary group who met and spoke almost daily to discuss best care practices as information came out daily. Using clear communication and discussion of risk/benefit, we were able to institute and change care recommendations. Our recent publications reflect our experience and recommendations regarding COVID-19 and neonates in the original epicenter, New York City.

How do you hope to see these guidelines implemented in neonatal intensive care units?

I hope that this is a baseline for other organizations to see what we were able to recommend for practice with the current information that we had and ways that we were able to convey it to staff as it changed. Information regarding COVID-19 care in mothers and infants will continue to evolve as we continue to learn more but this document may serve as a place to start.

"As a holistic mind-body exercise, tai chi leads to improvements in both physical ability and psychological well-being. This is important for adults with cardiovascular disease, since better psychological well-being is associated with a reduced risk of cardiovascular-related mortality," ~ Ruth Taylor-Piliae, PhD, RN, FAHA

“Tai Chi is generally considered a safe, low-impact, moderate-intensity exercise, making it a feasible option for adults with cardiovascular disease, including those with low exercise tolerance,” Dr. Taylor-Piliae says. “As a holistic mind-body exercise, tai chi leads to improvements in both physical ability and psychological well-being. This is important for adults with cardiovascular disease, since better psychological well-being is associated with a reduced risk of cardiovascular-related mortality.”

Cardiovascular diseases are lifelong chronic illnesses. Many patients experience unpleasant feelings or emotions – including depression, anxiety and stress – that affect their ability to live life to the fullest. Depressive symptoms, for instance, affect approximately 20% of patients with coronary heart disease, 20% of patients with heart failure, 27% of those with high blood pressure, and more than one-third (35%) of stroke survivors.

Studies of this activity in patients with cardiovascular disease have generally been small. However, Dr. Taylor-Piliae’s is the first to combine analysis of clinical trials from the past decade examining the effect of tai chi on psychological wellbeing in adults with coronary heart disease, heart failure, hypertension, and stroke. A total of 1,853 patients from 15 clinical trials were included in the analysis.

Dr. Taylor-Piliae found that tai chi was linked with less psychological distress as a whole. It was also associated with a reduction in depression. Patients with cardiovascular disease often have poor quality of life due to unpleasant symptoms, such as shortness of breath, or disability. The study found that tai chi was also associated with better quality of life, both mentally and physically.

More research is needed on how this mind-body activity exerts its mental health benefits. But Dr. Taylor-Piliae posits that the synergy between postures and breathing during tai chi exercise has a marked effect on enhanced mood. Her conclusion is that tai chi is ideal for people of any age or exercise ability and can be safely adapted for anybody, since people with low tolerance to exercise or breathing problems can practice it in a chair.

"I truly believe that receiving education from such an intelligent, devoted, and compassionate group of people has shaped who I am as a nurse," ~ Abbi Simpson, UArizona Nursing DNP Student

What is it like to be on the frontline of the COVID-19 pandemic?

This is a very stressful time—not just because of the risk of infection or of infecting loved ones, but because of the severity of illness caused by the virus. However, one thing that I don’t hear discussed as often is the emotional impact of working with patients and their loved ones through the devastation that the virus can cause. I work in a medical ICU with an incredible group of people, and I think that this is a very influential component, as most of us are driven by our passion for serving the community and love for our patients. There are moments when this feels overwhelming, but I often find myself feeling very inspired as I see the constant devotion, courage, strength, and resilience of my coworkers continuing to shine through.
 

Can you share your perspective of the challenges nurses face during this crisis working in ICU?

This situation has demanded an extraordinary level of flexibility and adaptability on all health care levels as daily practices continually change based on new information, resource availability, and the spread of the virus. For many nurses, this means caring for patients who are more commonly seen in other specialties in order to accommodate staffing needs for COVID patients, and adapting work flows due to fluctuations in resources. As a bedside ICU nurse, this is exacerbated when you add in personal protective equipment (PPE) because it changes your whole routine. It's hot, hard to talk, and by the end of the day, hard to breath. On top of all of this, you worry about everything you touch inside and outside the room, and wash your hands until they're cracked and raw.

How are nurses in your community fighting this epidemic?

Nurses in my community have responded to this epidemic in courageous and creative ways. There have been nurses from specialties that have had a reduced workload that have volunteered to get cross-trained to provide care for COVID patients as more of the population has been affected; nurses that have volunteered to support those providing direct patient care by assisting with PPE to help make sure that no one self-contaminates, acting as supply “runners” to limit the amount of donning and doffing each nurse has to do, and/or helping to wipe down frequently touched surfaces several times a day; and nurses who have been working behind the scenes by doing things like sewing masks and educating the public on social distancing and infection prevention measures. These efforts, and those of the nursing community at large, have been very inspiring and make me incredibly proud to be a nurse.

What are the biggest challenges you face?

Beyond the global struggle to persevere through the impacts of the virus and find a new normal, my biggest challenge has been reminding myself to take time for the things that nourish my mind, body, and spirit. Nurses are notoriously bad at self-care, and I’m no exception. However, with the challenges and chaos of COVID-19 on top of school, work, and the needs of my family, finding and maintaining balance is more difficult, but also more crucial, than it ever has been.

During these challenging times, what gives you hope and helps you stay positive?

The most encouraging thing has been the community support that health care workers have received. Community members have been sewing masks and surgical caps, businesses have donated supplies, and local restaurants have brought lunch for the entire hospital on multiple occasions. We’ve received countless letters and expressions of gratitude. Honestly, I feel honored to have the opportunity to serve my community during this time of need.

How have you managed your school work and your clinical work?

Trying to balance the two has been very difficult, especially in a time when everyone is already struggling to find a way to accept the reality of our current situation and learn to live in uncertainty. I admire many of my peers who have been able to do this. Trying to fulfill my responsibilities at work, manage my stress level, and also somehow conjure the energy and focus for school seemed like work best left to a magician. There are still many unknowns, but I’ve settled into the idea of constant change as the new normal, and with the support I’ve received from my family, advisor, and professors, that magician’s task has been a lot more doable.