"I would like to create a new model for helping people in urban areas. If we had a physician in the team, as well as other supports, they can help the caregiver and decrease the tension. It’s a first in an urban city like Bangkok.” ~ Lek Nisa Wongchan, palliative care nurse from Bangkok, Thailand

After clearing a slew of bureaucratic hurdles, Lek arrived in Tucson, aided by a four-month scholarship from Navamindradhiraj University in Bangkok, where she is a lecturer at the Kuakarun Faculty of Nursing. Her goal was to learn more about the use of telehealth in the U.S. palliative care system, but she brought with her a passion to not only learn but also to share her knowledge of Thailand’s end-of-life care traditions and methodologies.

Lek has practiced palliative care in her home country for 14 years, but the differences between the two systems are significant. In Thailand, nurses’ tools for helping people to remain in their homes throughout the end-of-life journey are limited. Nurses are solely responsible for all facets of palliative care, while in the U.S. they have a support specialty team comprised of multiple disciplines, including physicians, social workers and chaplains. In urban areas such as Bangkok, patients who wish to die at home are stymied by a lack of support that results in undesirable admissions to the hospital, where they can receive hospice care.

“If the patient would like to stay to live at their home,” Lek says, “they may not be able to because they don’t have anything to support them. There are no physicians, only nurses, and nurses cannot prescribe medication for the patient.” Using the knowledge she gained during her time at UArizona Nursing, she hopes to change that dynamic.

Her PhD dissertation presents a multi-disciplinary model that she created and plans to test in Thailand. “I would like to create a new model for helping people in urban areas,” Lek says. “If we had a physician in the team, as well as other supports, they can help the caregiver and decrease the tension. It’s a first in an urban city like Bangkok.”

Dr Shea explains, “Lek is trying to create a new model for the healthcare system, directed by the Thai government, to provide multi-disciplinary care for home-based palliative care.”

“In Thailand, the palliative care model is just the nurse going to the home,” says Lek. “But here the palliative care model includes multiple disciplines, so there’s a social worker, a chaplain and also the medical director, if needed. Dr. Shea helped me to learn the whole system here -- in education, community, the hospital, hospice care, and in-home care. Now I can compare.”

That comparison led to a fertile exchange of ideas between Lek and the health care hospice and palliative care professionals she worked with in Arizona. “In Thailand, hospice care is inpatient, as opposed to palliative care, which goes to the home to enable patients to stay at home until they die,” says Dr. Shea. “The difference between hospice and palliative care is very clear, unlike here, where we have a home hospice program and the inpatient unit is for use only when symptoms are not controllable in the home. Yet, palliative care cuts across all types of care because it’s about providing comfort. We’ve learned a lot from Lek because of their approach to palliative care is very spiritual, while ours is often very physical.”

Thailand’s undergraduate nursing programs require students to pass religion and ethics classes before they can begin their 3-month palliative care studies. Over 95% of Thai people practice Buddhism, where Making Merit becomes heightened during the final stages of life. Making Merit is a fundamental Thai Buddhist practice that focuses on the purpose and value of each day that is enhanced by good deeds, acts or thoughts. U.S. palliative care practices help patients to satisfy goals as opposed to focusing on fulfilling an individual’s purpose each day, an idea that struck a chord with the palliative care workers Lek encountered at Casa de la Luz Hospice. “The idea of each day having a purpose was a big ‘Aha’ for the nurse practitioner, social worker and chaplain,” says Dr. Shea. “That really clicked. They were so excited to learn from her.”

Lek shared her knowledge of Thailand’s universal health care system with UArizona Nursing Bachelor of Science in Nursing (BSN) students, visited simulation classes with Master’s Entry to the Profession of Nursing (MEPN) students and went on palliative care visits with Casa de la Luz staff. Dr.  Shea saw possibilities for more palliative care education but stated, “It’s hard to add any additional class time to our undergraduate nurses because, as educators, we have an obligation to provide the knowledge that will allow students to pass the Nursing Certification Licensure Exam (NCLEX) and there aren’t many palliative care questions.” Then added, “But I think there will be more emphasis in the future because we are seeing greater emphasis in this area.”

Lek’s visit to UArizona Nursing will hopefully be the beginning of a new international exchange of ideas, especially with the College’s burgeoning focus on global education. “That give-and-take has been so exciting, because it opens our eyes to other possibilities,” says Dr. Shea. “It’s one thing to read about other ideas and practices in the literature and say, ‘Oh, I read here that they do it this way,’ and another thing to actually talk to somebody who’s living it.”

Under Dr. McEwen’s leadership, UArizona Nursing will be among the first colleges to implement the UArizona Health Sciences’  global initiative.

“I am pleased that Dr.  McEwen has accepted the appointment as the first Associate Dean for Global Nursing,”  Dean Moore said.  “She now will be leading all of our global strategic initiatives that are closely aligned with the Health Sciences and UA strategic plans. We have an exciting opportunity to engage with new global partners seeking our academic programs.  Marylyn brings the ideal credentials and vision to lead global nursing at our university.”

 A fellow in the American Academy of Nursing’s global health expert panel, Dr. McEwen has co-authored immigrant health and border health white papers and published on health issues in the U.S.-Mexico border region. Her career has addressed wide-ranging global health concerns. “When I finished my undergraduate program, I knew I wanted to focus on global health,” she said.

In 1989, Dr. McEwen taught a rural community health rotation that brought nursing students to the U.S.-Mexico border for their public health nursing rotations. That was her first experience teaching in the border and it fueled her passion for achieving health equity and decreasing health disparities for people of Mexican origin in this unique geopolitical region. “I saw the border region as an amazingly rich environment in which to examine the multiple and diverse factors that influence health and well-being for people in two countries that share a common border,”  Dr. McEwen said.

Testament to her collaborative talents, Dr. McEwen provided leadership in a 15-year HRSA-funded interdisciplinary rural health training grant that focused on border/binational health, with students and faculty members from UArizona Nursing, Public Health, Pharmacy,  College of Medicine – Tucson, and Nutritional Sciences and  Arizona State University School of Social Work. Each  semester, with her UArizona College of Pharmacy colleague, she facilitated student tours of the Mexican health-care systems in Nogales, Sonora, Mexico,  and discussed local and binational health-care issues with Mexican health-care professionals. She is known for her interprofessional workforce development model for building community capacity, her community-centric program of research, as well as her culturally congruent community-based interventions to promote health.

“My research team  always has been composed of colleagues from diverse disciplines, including promotoras, or community health workers. I have extensive experience in conducting community-based research, primarily development and testing of culturally and linguistically tailored interventions, using a participatory research approach, with Mexican American adults with type 2 diabetes and their family members.”

Dr. McEwen has disseminated her research findings at international professional meetings in Ireland, Australia, Mexico and Italy.

UArizona Nursing’s global program has a head start, thanks to the college’s Global Nursing Advisory Group, which has developed partnerships with nursing programs in Sonora, Mexico; Universidad de Sonora (UNISON) School of Nursing in Hermosillo and Instituto Interamericano de Educacion Superior para la Salud in Guaymas. Dr. McEwen has been active in the work of the advisory group and, with another colleague, extended the Master’s Entry into Practice Nursing (MEPN) public health nursing clinical rotation to UNISON in Hermosillo last summer with eight  students. “We have an impressive group of faculty members at the College of Nursing who are committed to strengthening our Sonoran partnerships and extending teaching/learning opportunities with other partners in Mexico and Central America. I have no doubt they will fully embrace the microcampus concept as well.”

Dr. McEwen is excited about her increased capacity to champion global partnerships, not only for the increased exposure they will bring to UArizona Nursing, but for the benefits that both domestic and international students will receive. Ultimately, she would love to see a student exchange program established that would benefit every nation involved. “It’s a wonderful opportunity for our DNP students, and for our students across all program levels. Students who experience a  different health-care system in action is an amazing and professionally enriching opportunity. Students who learn about international health-care systems, compare and contrast those with the U.S. systems and  learn from one another strategies to  improve  their own practice and health-care delivery systems.”

UArizona Global Nursing is slated to start in fall 2020. Dr. McEwen, in responding to global partners’ requests, plans to begin with the entry-into-practice-level nursing program before extending into graduate and doctoral-level programs. The College will assess the capacity and readiness for prospective partners to engage in the program – determining prerequisites that must be met by students seeking entry into the program, faculty capacity and assessment of local health-care systems to support clinical experiences. The programs will be delivered in UA Global microcampuses, with the ultimate goal of allowing students to sit for state nursing board exams and potentially practice nursing in the United States.

“It’s such an amazing opportunity for global nursing to participate in an innovative model that promotes the health of the people through completion of a UArizona Nursing degree, improves the level of education by increasing local faculty capacity and ultimately elevates the delivery of health care,” Dr. McEwen said.

Why did you choose Arizona Nursing?

I chose Arizona Nursing because of their remarkable reputation. As soon as I heard that they approach their curriculum with a holistic view – I was sold! I really love that they incorporate integrative nursing into the program as well as promote diversity and inclusion.

What does being crowned Homecoming Queen mean to you?

To me, being named Homecoming Queen is far beyond just the title. I am so honored to be able to represent my on-campus involvement and the College of Nursing. The support I have received from both faculty and my peers, has reminded me how lucky I am to be a part of this college. Never in a million years would I have thought that as a first-generation college student from a small town in Illinois, would I be in the place I am today. With significant gratitude I can say, I will cherish this moment for the rest of my life and always remember the impact the University of Arizona had on me.

What features of your program are you especially passionate about?

I am extremely passionate about helping underserved populations, hence my decision to pursue the Peace Corps after graduation. However, this passion extends into every rotation throughout this program. Generally, it has been so gratifying being able to care for people of many backgrounds and cultures in their most vulnerable state. Additionally, I really am passionate about the pediatric population and how integrative nursing can really change a child’s fearful experience in a hospital/foreign setting. It has been so fun learning creative and fun ways to make a child comfortable and build trust within their nurses and providers.

Share your favorite memory from your time at Nursing

My favorite memory at the College of Nursing was when myself along with other ANIE students volunteered and helped with pharm camp for middle schoolers over the summer. It was so much fun to be able to teach and inspire young kids to not only attend college, but possibly pursue nursing! We taught them about the opioid crisis and had them participate in a mock code simulation due to opioid overdose, how to swaddle babies, and how to take vitals. I love working with kids, so it was really fun to answer their questions and teach them about the nursing profession.

What are your goals/plans for the future?

As of right now I plan to serve in the Peace Corps as a maternal and child health educator. Upon my return, I plan to utilize my skills in either an inpatient or outpatient setting. Eventually it is my goal to become a pediatric nurse practitioner and work in areas of low income and low resources to carry on my passion of helping underserved populations!

"Two of my children are culturally deaf and I’ve seen – in the process of learning as a parent – how deaf people struggle in the medical and mental health arena. I thought that there was something that we could do as health care professionals to encourage providers and people at the clinic to become more aware about deaf culture.” ~ Colleen Green, DNP student

Why choose Arizona Nursing for your DNP?

I graduated from the Bachelor of Science in Nursing program in 2017, so I went into nursing with a goal of completing a DNP. Arizona Nursing is one of the top programs in the country and I don’t think I’d want to go anywhere else.

What will the SAZAPN award do for you?

With a family of six, it would have been very hard for me to carry out the project. Having the money to disseminate the work makes everything a lot less stressful on me and my family than it otherwise would have been.

What is the inspiration behind your DNP project?

I’ve been thinking about this topic for the last five years. I studied it in my Bachelor’s program, and now for my DNP project. Two of my children are culturally deaf and I’ve seen – in the process of learning as a parent – how deaf people struggle in the medical and mental health arena. I thought that there was something that we could do as health care professionals to encourage providers and people at the clinic to become more aware about deaf culture. The main takeaway is that deaf people are capable and smart, and they can do anything that a hearing person can do, so it’s not that I need to be there to help them; I actually want to walk alongside them and partner with them to provide that education to providers and staff.

Tell us more about the scope of your project.

I’m looking at providers and staff in an entire clinic and their knowledge, skills and attitudes regarding culturally deaf people. Providing education to a clinic is difficult, because people’s time is limited, so I created the project to be interactive. It’s a series of YouTube videos that people are asked to watch. It takes less than 20 minutes a week and goes for four weeks. It’s flexible, so they can watch it on a TV in the break room, or they can watch it from their personal devices at home. Following that, they finish another survey to prepare and see if any of those factors have been removed as a result of the training.

It’s for providers but it’s also for the entire staff. If a deaf person walks into a clinic and the front desk person has never interacted with a deaf person before, they can immediately lose the feeling that it’s a safe place to be. I want to target anybody and everybody who works at the clinic all the way from the custodians to the maintenance person to the staff that’s at the front desk, not just providers.

Could this training be rolled out nationwide?

We need this kind of training everywhere, in hospitals, in clinics, in facilities that do mental health care, so, yes, the idea would be to do this training to at least start the conversation for culturally sensitive care.

What kind of reaction have you gotten from people who received the training?

A lot of people have come up and either started signing to me, to say ‘Hi,’ which is really cool, or they’ll say, ‘Wow, we were watching this video and this is really great content because in all the content it’s culturally deaf people speaking for themselves.’

What are your hopes for the future?

I hope to teach part time as a nursing instructor and be able to integrate what I’ve learned about this population for other young nurses coming into the field. And then I want to part time practice and hopefully integrate some telehealth into working with culturally deaf people in the future.

"The UArizona GNHE Old Main 'Building Brighter Futures in the College of Nursing’ Brick Award was a tremendous surprise and much appreciated.  This has special meaning since it was also the inaugural award.  Dr. Miller explained how this brick represents the history of excellence in education at the University of Arizona and how she would like us to use this brick to acknowledge outstanding members of the CON who are ‘Building Brighter Futures in the Collage of Nursing.'

The brick award was truly an honor.  Coordinator work is largely behind the scenes and it was nice to hear of the appreciation for leadership, mentorship, teamwork and growth produced at the Phoenix site as well as division wide accomplishments such as ExamSoft.  However, this award symbolizes more than an individual award.  No site could have accomplished what we have accomplished from the help of one person.   To me, this brick represents the teamwork of all who helped launch and grow the Phoenix site with the many opportunities and successes including clinical and classroom placement and all of the moving parts that are too numerous to explain."

Deb Gorombei, DNP, RN, CFRN, LNCC, Clinical Assistant Professor

"I certainly was flattered and humbled with receiving this award.  As my professional colleagues know, I am not one to place a great deal of emphasis on such things.  I respect and value what the “Old Main Brick Award” symbolizes.  I believe it is important to acknowledge the historical significance and legacy of the University of Arizona.  It is also important to acknowledge key individuals who came before us and the contributions they made to UArizona.  Universities are complex and multifaceted in addition to being a living and breathing organism in flux, constant evolvement, and change.  For me, the brick and other assorted artifacts represent the humble beginnings of the University of Arizona from a historical perspective.  They also represent the core values and principles upon which the University of Arizona was founded.  It is important not to lose sight of this and to keep things in perspective."      

Vlad Semin, FNP, MS, CCRN, Instructor, Phoenix MEPN Program

"Dr. Deborah Gorombei and Vladimir Semin passed on the award to me. Here is an excerpt from the presentation of the award: “Deb and I wanted to take the time and publicly thank Ms. Jocelyn for her immense contribution and leadership to the MEPN program in Phoenix.  She has been the sound voice of reason, faculty leader, resource, and mentor.  She has also gone above and beyond with her flexibility and assistance to the MEPN cause with unwavering devotion and commitment. The “Old Main” historic brick, is presented to Ms. Jocelyn Nelms, which symbolizes UArizona excellence."

Jocelyn Nelms, MS/Ned, RN, Senior Lecturer

"Receiving the Old Main Brick Award this August 2019 was, to say the least, a complete and total surprise.  After recovering from the surprise (a hot flash to be exact!), it became a welcomed and deeply appreciated “vote of confidence” after a couple of busy, and at times, stressful semesters.  Much of what we all do is quiet and “behind the scenes” as we try to do what’s best for our students, courses, and nursing programs.  This award was like a gentle pat on the shoulder, that said “nice job!”  I am honored to get to hand it off to the next deserving colleague!"

Sharon Hitchcock, DNP, RN-C, Clinical Assistant Professor

"I was surprised, honored and very excited when receiving the Old Main Brick Award. Dr. Hitchcock acknowledged my efforts for teamwork as well as going above and beyond for advocating for student success.  To me, this brick is truly a symbol of building brighter futures. I am privileged to be a faculty team member at The University of Arizona as I get to share my passion with students every day. I want to share an excerpt from a student that I received ironically the same day as this award: “Thank you so much for being an advocate for our learning! You were a great help with our transition into the hospital setting. Thank you for being so patient and so kind. You have helped me grow so much during Pediatrics.” 

Beverly Bias, MS, RNC-NIC, Lecturer

When he was brainstorming his dissertation, Fiske, who graduates from the DNP program in December, realized that the need for nurses to administer the ASI test would be beneficial for patients and providers alike. “The ASI is intended to establish whether the person who is walking through the door has accepted that substance use is a significant problem in their life,” explains Fiske. “It helps determine if they need treatment, and also to understand whether they have accepted that other factors are affecting their use of substance, including family or medical issues. You have to deal with those underlying issues to get to the substance problem.”

The ASI interview yields two different measures: the Interviewer Severity Ratings and the Composite Scores. The Interviewer Severity Ratings are qualitative items that provide a summary for people who want a quick general profile of a client's problem status in each section of the ASI. Composite Scores are mathematically sound measures of change in problem status. The Composite Scores were developed to provide reliable and valid measures of patient status in each area of the ASI; measures can be compared at the beginning of treatment and a subsequent evaluation points to note improvement or the lack thereof.

In addition to helping devise a treatment strategy, the ASI is also useful for psychotherapy because results indicate whether the patient would benefit from psychotherapy or chemical therapy. “For psychotherapy, you want to be able to establish what is most important for this patient and focus on that. It’s proven that if you can maintain a person in a substance abuse program for at least a year then the possibility of relapse becomes even less,” Fiske says.

Training medical providers – including nurses – to effectively administer the ASI is key to the success of the assessment tool. Fiske conducted a one-day training at Marana Health that provided training on two different levels: to train providers to understand what the scores they will be looking at mean and also to train nurses how to provide the assessment. “It’s one thing for providers to look at the score,” Fiske says. “But if the nurses who will be asking those questions are not asking them properly, they could provide wrong Composite Scores and wrong addiction severity scores.”

Marana Health Center was impressed enough with Fiske’s ASI innovations that it adopted the program for use with addiction treatment. After new patients receive a psychiatric evaluation from a physician, Fiske takes over as point person for the ASI. “I sit with then for 30 minutes and I do the ASI,” Fiske says. “Whatever the psych evaluation reveals, the ASI balances that information. If the person has a problem it shows, because the psychiatric evaluation complements the ASI. We assess for depression, anxiety, and psychosis. It’s important for psychotherapy because once the person is going for psychotherapy, then they can focus on what they need to address their problems.”

A native of West Africa, Fiske has taken a long and sometimes arduous journey to his current doctoral studies. He holds a bachelor’s degree in political science and history from the University of Ghana, and a bachelor’s of science in nursing and a master’s in professional communication from East Tennessee State University. He has worked as a war reporter and as a research analyst in Liberia’s Office of the President and spent time as a refugee from his war-torn home country. “All of those things motivated me pursue a career that would make it possible to be able to help people more significantly,” he says.

As for the future, Fiske plans on giving back to his home country. He is motivated by his desire to aid disadvantaged communities through the spread of up-to-date health care strategies. After he earns his DNP, he plans to work in the U.S., save money and ultimately build a teaching clinic in Liberia. He hopes to structure the clinic so that nurses from both Liberia and the U.S. can rotate between countries, thereby increasing their knowledge of new research and growing their capacity to deliver health care. “I’m interested in bridging this gap by having people go over, and come over and do rotations,” he says. “This is my philosophy: Everybody cannot migrate to the Unites States of America. But the United States can migrate to people in those ways. In the realm of science and medicine we can reach out – and that is truly significant.”

"Bed Sled has the potential to appeal to a global market. Sometimes, it doesn’t have to be a complex change that makes a profound difference to prevent adverse consequences and promote health.” ~ Laura McRee, DNP, ACNP-BC, LMT, RNFA

The innovative resistance training device promotes movement for a patient’s lower legs for movement and varied levels of resistance, thereby preventing muscle de-conditioning and venous stasis which can lead to 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 usage, number of repetitions and level of resistance.  

“Long periods of immobility have ravaging effects on your body,” Dr. McRee says, noting that people with mobility issues 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 sequential compression devices. Unlike those solution, Dr. McRee points out, the Bed Sled has no negative side effects. “It’s ideal if you can engage the muscles the natural way to prevent DVT and muscle conditioning,” she says. “Nothing like it is available in the marketplace right now. One of the best things is that 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.”

After participating in NSF I-Corps program managed by TLA – a six-week course that teaches lean startup methods and helps academic entrepreneurs learn about customer discovery –  Dr. McRee connected with Mark Baker, TLA commercialization partner. With Baker’s help, she secured asset development funding from TLA to build two successive functional prototypes. Reviews by engineers and physical therapist fine-tuned the invention, which ultimately led to the patent application.

“The current sled will definitely work in a hospital bed,” Dr. McRee says. Usability testing on the next prototype, which is in development now, with help finalize the device.

Kaitlyn Norman-Powers, TLA Licensing Manager for UA Health Sciences, has high expectations for the Bed Sled’s future. “We’re hoping by spring of next year that we have a really good working prototype that can be licensed to the startup so they can start going out to potential customers,” she says. Once the intellectual property protection is in place, Norman-Powers says, the device will be licensed to a start-up company, which will aid in commercializing the final version. Demand is anticipated to be substantial, since according to the National Care Planning Council, there are about 1.7 million beds in nursing homes in the U.S. alone and an estimated 19.6 million hospital beds in the world.

Dr. 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, she is gaining the expertise to expand commercial possibilities for the Bed-Sled and to target a broader base of customers. Current customer bases include hospitals and nursing homes, medical supply firms, home users and travelers who face the risks of extended periods of immobility. “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.”