Mosima Choshi

PhD candidate, expected graduation in August 2017; from South Africa

Why did you decide to pursue a nursing degree?

I was born and raised in rural South Africa, where health care services are either unavailable or inaccessible. When I was 12 years old I saw my mother lovingly take care of my late grandmother using traditional medicines from a medicine man. Without help or guidance, she did the best she could. After graduating from high school, I went to the local hospital and knocked at the door of “The Matron,” which is what they call the Chief Nursing Officer, and told her I wanted to be a nurse because I wanted to be able to better take care of my mother if she gets sick and build a clinic at my local village for all the villagers to get health care.  

What drew you to the UA College of Nursing?

When I started at the University of Arizona College of Nursing it was for convenience. I was a full-time employee and a single mother raising my teenage son and had just moved to the United States. I was still struggling with understanding American culture, so it was a very challenging time. The College’s mission and values gave me comfort and motivation, especially its values of balance and social responsibility.

What features of your program are you especially passionate about?

My research topic was self-care behaviors of rural women post-invasive coronary interventions. Rural women and cardiovascular disease are my passion. Working with rural health expert, Dr. Sally Reel , and cardiovascular health expert, Dr. Anne Rosenfeld, was all I could ever ask for. To top it off, I had the opportunity to start my rural cardiovascular health career by working with rural populations during my dissertation. 

Share your favorite memory from your time at the CON.

Attending RISE [Residential Intensive Summer Experience, an on-campus intensive for PhD and DNP students] was my favorite time in the whole program and I was very sad when I couldn’t attend anymore. To meet with my cohort, my professors and the IT people was always very exciting. 

How do you intend to Build Better Futures?

For me, nursing is the center and the pillar of health care provision. Through research and teaching, I will make an impact on the nursing practice and nursing profession. Building a better nursing future is not only for nurses, but also for the populations receiving the nursing care. Heart disease is a number one killer worldwide, but most people do not know that. Empowering the new nursing generation to disseminate the knowledge they acquired to the populations they serve is the key to disease management, including lower mortality and morbidity rates. The one-size-fits-all approach to health care is not practical and rural populations’ perceptions of health are different from urban populations’ perceptions of health. New health innovations must be disseminated using methods that are suitable for specific populations and communities.

Eric Smith is a Bachelor of Science in Nursing (BSN) student at the University of Arizona College of Nursing and a UA Foundation scholarship recipient. He is also an eagle scout and a former firefighter.

During the 2014 University of Arizona College of Nursing Donor Appreciation Tea, Ishmail Sillah, a student in the Master's Entry into the Profession of Nursing (MEPN) program, shares how his experience growing up in war-torn Sierra Leone and having limited health care access inspired him to become a nurse.

University of Arizona College of Nursing Clinical Assistant Professor Patricia Daly, PhD, FNP-BC, ENP-BC, has been an emergency and urgent care nurse practitioner for more than 25 years. A 2013 graduate from the UA College of Nursing PhD program, she has championed integrative nursing techniques throughout her career. Currently, she investigates mindful-eating interventions to address obesity in adolescents and adults. We sat down with her recently to discuss her history with integrative health care.

How do you incorporate integrative health into pain management?

My interest actually began when I was working in emergency room nursing. Back then, adult and child patients were often kept in the same area, and working with children was a real focus of mine. Whenever I’d have to suture someone I’d explain that they’ll want to focus their attention away from the pain. For children the kindest thing you can be is fast, but you also want to engage their mind somewhere else. I began telling children participatory stories to help that distraction. It’s actually a real integrative therapy called guided imagery, a powerful psychological strategy that enhances coping skills. I can time the story to the length of the suture, so if need be it can be a very long story. But the child is always the hero. Interestingly, adults who happened to overhear these stories started asking me to tell them stories, too. They would also be the heroes if the story, but I’d always start out with, ‘You just won the lottery. Where are you going to travel?’ and go from there. It was a really effective use of integrative therapy and I still employ it today.

You’re a big advocate of alternative pain management. Can you tell us about that?

In all my years in the ER, I have never written a prescription for more than six narcotic pills because I think pain management is not done best with pharmacological agents. Considering today’s opioid epidemic, that’s really important. Almost every narcotic addict is addicted because one of us wrote the first script. They told them, ‘Take this for pain,’ when they should have said ‘You’re going to have pain and that’s not going to kill you, but that drug might kill you.’ I teach nurse practitioners that when someone is drug-seeking that person has a health care issue: its addiction. If you just write them a prescription for some medicine you’ve done nothing but perpetuate the problem. I tell students ‘Okay, try to go in that room and make it a win-win. You are not giving the narcotic pain prescription and the patient’s going to leave satisfied. That is your goal.’ That person is suffering and so it’s important to listen to the patient, and that’s what integrative health is about: the whole person.

How has integrative care changed over the years?

From my perspective, nursing has always been integrative. In the ‘70s, the definition of nursing was ‘helping people cope with illness or changes in their life cycle.’ That’s why nursing was always strong in hospice, always strong in end-of-life care. Comparatively, disease-focused models, or germ theory, for the most part doesn’t work. Health has to do with how much sleep you get, what you eat and other lifestyle choices. It’s important to realize that almost all of pharmacology imitates what your body does. Why can a Yogi lower their blood pressure at will without a beta-blocker? How can someone walk across hot coals without serious injury? The receptors that drugs tie to in your brain or other parts of your body didn’t grow there because they thought you might make a drug someday that might go there. That’s your body chemistry.  For some people it’s very controllable, and that’s where eastern medicine kind of came from. There is something more than we can measure, and I feel like nurses always know that.

How do you inform your students about the importance of integrative care?

I talk to students about balance constantly. In nursing, that’s especially true because a lot of them are overachievers. They can work all night. They have so much compassion, and they are so giving of themselves to the point where they don’t fill themselves back up. In the end, it’s about life balance. That’s true for almost every patient, too: You help them try to find some life balance, and integrative nursing is the way that’s done.

Moving toward a more progressive and culturally relevant approach to Native American health care, Indian Health Services (IHS) and the Centers for Medicare and Medicaid Services require culturally sensitive care in health care settings. In an effort to demonstrate this cultural competency, IHS hospitals now offer Native American healing ceremonies provided by traditional practitioners. But native ceremonial practices in these hospital settings are often curbed by hospital policy, according to Dr. Michelle Kahn-John, assistant professor at the University of Arizona College of Nursing. Now in the final stages of a two-year research project, Dr. Kahn-John, along with her collaborative team at the Tsehootsooi Medical Center in Fort Defiance, AZ, is assessing the effects of a traditional Diné (Navajo) healing ceremony on individuals suffering from emotional distress. She intends to make a case for expanding the role of traditional healers/practitioners in Indian health care and tribal settings and bring recognition to the value of traditional Native American healing and ceremonial approaches to health and wellbeing.

Tell us about your research project.

We are exploring symptoms of emotional distress and stress-related inflammation before and after a traditional Native American ceremonial healing intervention, present for centuries within the culture. We are seeking culturally congruent ways to impact the Native populations experience increased rates of mental health conditions, including depression, emotional distress and trauma and suicide. I am interested in knowing more about the innate strengths and protective factors associated with Diné culture and whether partaking in traditional ceremonies will improve physical and psychological health. Overall, the intent of this work is to enhance the health and wellbeing of native communities.

Can you tell us about the healing ceremony?

The Diné ceremony is a cleansing ceremony recommended for those dealing with grief, loss, trauma or a stressful life transition. Very little can be shared about the process of the sacred healing ceremony, as I’m obligated to the Navajo Nation and Hataałii Hózhóni, the medicine man/chanter who conducted the ceremonies, to maintain the privacy of the ceremonial process. Hózhóni works at the Tseéhootsooí Medical Center and conducted 25 ceremonies for this project. The ceremony lasts about two hours and involves chanting, prayer, offerings, and body-mind-spirit purification.

Can you share your inspiration for this project?

In my nursing practice I’ve seen individuals who have sought out Diné traditional healing and have found very effective paths to healing and recovery for their emotional and spiritual distress. Of my 22 years as a nurse, 17 of which have been with the Navajo Nation as a psychiatric mental health nurse practitioner, I’ve focused on patients who have serious depression, post-traumatic stress disorder, complex trauma, anxiety and chronic and severe mental illness.  Typically, we offer them standard western treatment: counseling, medications, group therapy and family therapy, and those approaches are mostly helpful and effective. But I really wanted to explore combining those with the healing potential of traditional practices – and approach we term integrative.

What is particularly unique about this approach?

I recognize that healing ceremonies are sacred to native people. Ceremonial processes are held in high regard by myself, the Hataałii, and Diné. Some may question the intent of assessing outcomes of ceremony within a research agenda, but my intent is to enhance the health of the Diné while exploring the outcomes of ceremonial practices which have been present for hundreds of years. My intention is careful and respectful and therefore we will not share the specific elements of the ceremony, but will focus on outcomes of the ceremony.

How does this project relate to integrative nursing and health?

Integrative nursing principles are congruent with the philosophy of Native American healing and ceremony. The first principle of integrative nursing is ‘human beings are whole systems inseparable from their environment’ and another principle is ‘nature has healing and restorative properties.’ The Diné healing ceremony addresses the complete patient, their body, mind, spirit, family and environment, and places them at the center of a healing intervention. As nurses and healers, it’s critical that we expand our awareness and knowledge of the multiple paths leading to health and wellbeing.

A nurse for 22 years and a psychiatric mental health nurse practitioner for 17, Michelle Kahn-John, PhD, RN, PMHNP-BC, GNP, has spent most of her career working with the Indian Health Service on the Navajo Nation in Arizona. In 2005, she led efforts to establish the first inpatient adolescent psychiatric unit for American Indians on a reservation, where cultural wisdom and healing were integrated into the treatment model. Her work continues to shed light on the beauty and the value in Native American cultural wisdom and healing practices.

“There’s a life lesson here: It’s not about you,” Barbara Rector tells residents and guests gathered on a shaded veranda at The Hacienda at the River, the latest assisted living community in the Watermark Retirement group. Behind her, a pair of majestic horses nibble hay, awaiting the morning’s therapy session. “Approach carefully, respect boundaries and be patient,” continues Rector, the Tucson equine therapy pioneer who directs the program. “If the horse doesn’t respond, don’t take it personally. The experience brings you outside yourself for the needs of another being.”

That caring philosophy extends beyond the horse corral to almost every facet of life at The Hacienda. Located at the base of the Catalina Foothills, within a stone’s throw of the Rillito River, the sprawling Spanish-style facility is peppered with native plants, picturesque gardens and soothing green spaces. Baby hummingbirds quietly nest within the branches of a tree near a burbling fountain. It feels more like a desert-bound luxury getaway than an independent living, assisted living and memory care community. But thanks to a partnership with the University of Arizona College of Nursing and its one-of-a-kind Integrative Nursing Faculty Fellowship (INFF), the Hacienda will be a unique environment where nurse faculty can practice and nurse students can learn relationship-centered, whole-person care that inspires optimal health and wellbeing – person and environment synergy at its max.

“Everything we use on this property is healthy. If trees bear fruit, they're edible. The herbs grown here will be used in the kitchen for residents' meals." ~ Dr. Deborah Williams, PhD, MPH, RN

“As the liaison between the College and Watermark Communities, my role is to carry this vision forward,” says Clinical Assistant Professor Deborah Williams, PhD, MPH, RN. “Everything we use on this property is healthy. If trees bear fruit, they’re edible. The herbs grown here will be used in the kitchen for residents’ meals.”

In addition to the equine therapy program, other integrative therapies offered at The Hacienda include aromatherapy, reflexology, acupressure and acupuncture. Horticultural therapeutic programming will also be featured at some of The Hacienda’s green spaces, and aquatic therapies and swimming will be presented at the therapy pool. All of it is geared toward encouraging a personal wellbeing for residents that resonates physically, spiritually and emotionally. The attention to detail benefits the day-to-day wellbeing of the residents, but it’s also part of a larger research initiative that draws on the College’s integrative health expertise.

Thanks to the early planning by Dr. Mary Koithan, UA College of Nursing associate dean for student support and community engagement, The Hacienda’s facilities will be a ‘living laboratory’ for the College of Nursing. “It was essential that we bring in students so they can learn what it really means to take care of someone in an integrative way,” says Dr. Williams. INFF Fellows, bachelor of science in nursing (BSN), doctor of nursing practice (DNP), and PhD nursing students will rotate through the community.

 “Moreover, we intend to quench our thirst for new knowledge. We will be assessing how integrative care therapies affect the quality of life of the residents,” says Dr. Williams. “I’m really interested in propelling nursing science forward so we can say, ‘Look, these techniques do affect health in a positive way, and here’s the evidence behind it.’” A fellow in the first INFF, Williams incorporated the integrative knowledge she gained into the classes she teaches and was encouraged by student responses. She noted that after discussions of aromatherapy and acupressure, students developing care plans for patients broadened their toolkits. “Instead of immediately going to Tylenol, they would ask patients, ‘Are you willing to try this other approach?” she says.

The benefits of integrative health techniques are manifold.  For example, therapeutic equine therapy programs are increasingly recognized as a viable form of occupational therapy and rehabilitative care after injury and illness. Evidence points to increased compassion, sense of purpose and confidence for seniors who interact with horses. Evidence from a recent research project measuring the heart rate of horses and the people interacting with them showed that the meditative heart rate of a horse at peace will actually sync with the person’s and calm their pulse. Gazing into the languid brown eyes of Joe and Prissy, two of the horses at The Hacienda, it’s easy to see why.

A new understanding and appreciation is opening up around integrative health. Thanks to programs like the INFF, which bring together inquisitive nursing faculty from across the country to learn about integrative health, and partnerships like the one with The Hacienda at the River, the UA College of Nursing strives to be on the forefront of that frontier. “It definitely changed my life,” Dr. Williams says of her involvement in integrative care. “Nature heals. And I know it changes the students’ lives, too. They no longer think within the parameters of medication first. It brings a whole new perspective of what it means to holistically care for a person.”