Melanie Begaye

First-year Master of Science for Entry to the Profession of Nursing (MEPN) student
B.S. in Nutritional Sciences with an emphasis in dietetics from the UA; from White Clay, AZ

Why did you decide to pursue a nursing degree?

I wanted to be a caring, compassionate, yet confident figure that advocates for the patient. In the past two years that I’ve conducted research and worked on other projects with Dr. Mary Koithan in the College of Nursing, one of the most important things I’ve learned is that nursing is so much more than just monitoring the patient. It’s important to hear the voice of the patient, help them have control of their care, be the figure that gives them the attention and care when they need it, and play a role in healthy habit promotion and disease prevention outside of the clinical setting.

What drew you to the UA College of Nursing?

I was drawn to the UA College of Nursing through the Partnership for Native American Cancer Prevention (NACP) undergraduate research program. Although I initially wanted to be a clinical dietitian, I began researching with Dr. Koithan. We focused on alternative and palliative therapies for cancer care side effects and quality of life improvement. In addition, I was given the opportunity to work with many nurses of different backgrounds and specialties from the college and from the community. These individuals offered amazing perspectives on the impact that a nurse may have on an individual and the community. I realized that being a nurse would help me achieve my goal of returning to the Navajo Nation and promoting wellness and traditional healing. 

What features of your program are you especially passionate about?

For the MEPN program, I'm excited about the fast pace and the immense amount of knowledge I can gain from an extraordinary range of talented, experienced nurses. I'm most passionate about caring for my future patients on the individual level and providing that important care that is crucial to a patient at their most vulnerable point. 

Share your favorite memory from your time at the CON.

Every day is an adventure for me at the College of Nursing. My favorite memories include the many light-hearted meetings with Dr. Koithan and the Tohono O'odham translators, Darlene and Linus, applying the final touches on my two research posters to present to the NACP panel, and, of course, performing my first head-to-toe physical assessment as a student nurse. 

How do you intend to Build Better Futures?

I intend to build better futures by inspiring future nurses by being a supportive, devoted role model. I also wish to continue my current project which is the creation and dissemination of cancer education materials in the Tohono O’odham (TO) language. This project, a collaboration of the UA CON and Tohono O’odham Cancer Program focuses on the translation of cancer overview guides into TO. These education materials are videos narrated in TO and utilize culturally appropriate images. So far, these materials have been distributed to TO area hospitals and to Community Health Representatives so that they are easily accessible to TO community members. Once I complete my degree program and have more expertise in patient care and the healthcare systems, I hope to expand this project to other chronic disease states, such as diabetes and cardiovascular disease, and to other Native American groups like the Hopi, Navajo, and Apache. This type of community health education should increase the Native American public’s knowledge on disease states and promote health behaviors like disease prevention, early diagnosis, and treatment compliance. These outcomes should increase quality of life in Native American patients and improve overall health in rural and urban native communities.

Arizona is home to 10,000 actively licensed massage therapists, each of whom averages 12 clients per week or roughly 7,000 client encounters a year. What if in addition to soothing cramped muscles those massage therapists could be enlisted and trained to help reduce skin cancer risk?

University of Arizona College of Nursing associate professor Lois J. Loescher, PhD, RN, FAAN, aims to answer that question thanks to a three-year $750,000 award from Arizona Biomedical Research Commission (ABRC) to train massage therapists, with their unique access to skin, to effectively communicate sun safety, identify and recognize suspicious skin lesions and provide resources for appropriate health care follow-up for their clients.

The study, “Massage Therapists Skin Health Awareness, Referral, and Education (MTsSHARE) to Reduce Skin Cancer Risk in Arizonans,” aims to address, expand and evaluate the effectiveness of skin surveillance in an innovative and previously unaddressed way.

According to the American Cancer Society, skin cancer is the most common form of cancer in the U.S., with more than five million cases occurring annually. In Arizona – a state that enjoys 299 sunny days a year – the incidence of non-melanoma skin cancer is three to six times higher than in the northern United States. Besides serious dangers like death and disfigurement, the costs of treating skin cancer exceed billions of dollars every year – another reason that early detection is so crucial.

“Our goal is to have a huge public health impact in skin cancer prevention and early detection...we want to promote a larger role for skin cancer prevention within massage therapy schools curricula and continuing education" ~ Lois Loescher, PhD, RN, FAAN

“We’re not suggesting that massage therapists should become dermatologists,” said Dr. Loescher. “All we’re doing is advocating for another pair of eyes on the skin.” Currently, massage therapists receive little formal training on skin cancer so Dr. Loescher and her team are developing online training that could be successfully adopted by massage schools in Arizona and beyond.

Adapting a prior intervention developed by Dr. Loescher and her co-investigators, Myra Miramoto, MD, MPH and Amy Howerter, PhD, from the UA College of Medicine – Tucson’s Department of Family and Community Medicine, the team will conduct pilot testing on 20 Tucson-based massage therapists. After fine-tuning the intervention, they will expand to a larger group of 80 massage therapists throughout Arizona. Effectiveness of the training will be tested after participants complete the online learning program. Additionally, the massage therapists’ ability to deliver sun safety information and assess skin lesions in their clients will be tested through specific visits from ‘secret shoppers,’ who are simulated clients with removable tattoos of questionable skin growths.

“Massage therapists see their clients more often than primary care providers see their patients,” said Dr. Loescher. “Although most melanomas are diagnosed by physicians, they typically are detected through observations from the patients themselves or someone who is close to the patient.” Dr. Loescher wants to empower massage therapists to assist in detection and help clients understand the importance of sun safety, recognize suspicious skin lesions and recommend follow-up with a dermatologist.

“Our goal is to have a huge public health impact in skin cancer prevention and early detection,” said Dr. Loescher. “Overall, we want to promote a larger role for skin cancer prevention within massage therapy school curricula and continuing education.”

Not only would a creative, expert online training program be an affordable way to impart knowledge, but it would have the capacity to be widely disseminated across the country, said Dr. Loescher.

Dr. Loescher sees this study as only a beginning to expanding the number of informed eyes that are trained on skin, including service providers such as hair stylists, estheticians and even tattoo artists. “We’ve done a lot of due diligence,” said Loescher, citing two recently submitted manuscripts from pilot work on this topic. “We have set the stage in a very rigorous way to take this study the distance and beyond.”

Since the inception of telehealth, remote care has become increasingly widespread, enabling areas with limited access to health care to connect with providers from afar. To reach remote communities, more than half of all U.S. hospitals currently have a telemedicine program and the global telemedicine technologies market is predicted to grow at a compound annual growth rate of 18.4 percent by 2020. But there’s a key area where the technology’s potential remains untapped: Nursing school, and the University of Arizona College of Nursing’s Rene Love, PhD and Jane Carrington, PhD are about to change that with a new federally-funded grant project.

The “Using 21st Century Technology for NP Student-Patient Interview and Interprofessional Care Coordination” project, funded by a $26,000 Graduate Nursing Education grant from Centers for Medicare & Medicaid Services (CMS), has two main thrusts: to develop a telehealth learning program designed to be embedded in the College’s curriculum, and to evaluate the telehealth education experience for students.

“When nursing graduates go for interviews, employers are asking if they have experience with telehealth,” said Dr. Love, clinical associate professor for the Community and Systems Health Science Division at the College. The answer to the question is no, because although telehealth is widely used in health care, no training is currently offered on the scholastic level. “Our study is unique because telehealth exists in the working world, but not in the education setting,” said Dr. Love.

One hundred students will be chosen to participate in the program. They will videoconference with actor-patients who will participate via video call with a variety of health-related conditions. “Our students will call them computer-to-computer and do a health assessment just like you would do in an office setting,” explained Dr. Love. Students will then electronically communicate with volunteer health care providers that partner with the College to develop a patient summary, including treatment.

“We want to hear what it’s like to talk to a patient through a computer rather than in person,” said Dr. Love. “How comfortable are they with that dynamic? This is something they may have to do one day, so we want to know more about their interactions with it.” Also, learning to collaborate on services with another provider, Dr. Love points out, is a big part of successful telehealth programs. “They’ll get experience working with both patients and with a provider,” she said.

While Dr. Love coordinates with students, providers and the simulated patients, Dr. Carrington, will employ her informatics expertise in the evaluation of the technology and usability components of the project. “We want the program to be clear, easy to read, and easy to navigate, so that it becomes what I call ‘invisible technology,’” she said. “In other words, the technology should be so easy to use that it’s nearly invisible to the user for accomplishing the tasks. You should be able to go in, get what you need and leave. When it’s not invisible, the technology may be preventing you from doing your work in some way.”

Dr. Love and Dr. Carrington’s innovative research combines education, preparation and practice to emphasize learning about the telehealth process. “Our goal is that students who go through our program will have contemporary learning experiences within their education so they can accommodate whatever telehealth growth occurs wherever they go in the future,” said Dr. Carrington.

When University of Arizona College of Nursing professor Judith S. Gordon helped develop Click City: Tobacco, a landmark school-based tobacco prevention program from 2005-2012, she had no way of knowing the threat of e-cigarettes was just over the horizon. Thanks to a $225,000 National Institutes of Health Small Business Innovation Research (SBIR) grant, Gordon and Primary Investigator Dr. Judy A. Andrews of the Oregon Research Institute will update the online program to address the hazards of Electronic Nicotine Delivery Devices (ENDS), better known as e-cigarettes. In keeping with the College’s focus on harnessing technological innovation, the enhancement will also increase the program’s potential reach by expanding the types of devices on which it can be delivered.

Originally developed and tested in Oregon, the first iteration of Click City: Tobacco was based on a methodical, analytical approach to creating and testing the nicotine use prevention program. While other programs create a curriculum comprised of various components that have not necessarily been fully tested before dissemination, Gordon’s team painstakingly tested each element of the program. “We used an approach based on optimized designs where we developed each component and then tested it individually to make sure it was effective before it was included in the final program,” said Gordon.

The new and improved version of Click City: Tobacco will involve the same methodology to expand the program to include content about the risks posed by e-cigarette use. “The e-cigarette phenomenon has really exploded since we originally developed this program. Now kids are much more likely to use e-cigarettes than they are to use traditional cigarettes,” explained Gordon. “We also need to reprogram Click City: Tobacco so that it works on multiple devices that didn’t exist when we first designed it.”

The updates are designed to inform students of the risk factors around e-cigarettes, which ultimately will lead to changed perceptions of e-cigarettes. “Right now, kids think there’s no-risk in using e-cigarettes, so we want to make sure they understand the dangers involved, not only now but in the future. We want to teach them what e-cigarettes are, and change their perceptions of the device. For example, they don’t even know there’s such a thing as second-hand vapor.”

Gordon believes that the evidence-based methodology her team is using to create and evaluate the new Click City: Tobacco will lead to a scientifically sound and effective product. Also, since the program is a completely self-contained online educational tool, all a teacher has to do is set the students up with the program. “Our program is ‘plug and play,’” said Gordon. “The intervention gets delivered with complete fidelity because it’s delivered the same way every single time. It also generates reports so teachers can see how well a student is doing.”

The first version of Click City: Tobacco was a huge success with students, teachers and parents, who enjoyed it for its fun, game-based delivery but also appreciated its educational effectiveness.  The SBIR grant is meant to promote collaboration between researchers and small business developers, will enable her team to create a product that will be easily disseminated across the country. “The goal is to develop and create products that have an evidence base,” said Gordon. “So instead of businesses selling products that don’t work and academics and researchers creating effective programs that nobody ever uses, the government has created a mechanism that speeds this collaboration and creates a conduit for the commercialization of effective products.”

In keeping with the University of Arizona College of Nursing focus on integrative health and wellness to the forefront, its resident therapy dog, Hannah periodically patrols the College halls as a stress-buster. Meeting Hannah when you’re having a stressful or difficult time is a calming experience – all thanks to her therapeutic, empathetic temperament.

In 2014 faculty member Sheri Carson, MSN, RN, CPNP, kick started a novel therapy program with Hannah, her eight-year-old Golden Retriever, to decrease student related stress and test anxiety as well as faculty and staff work-related stress. “Working in pediatrics, I had experiences with therapy animals and personally saw the positive effect of therapy animals on children who are sick or on family members with a loved one in the hospital,” said Carson. “I felt like it would be a good fit for the academic setting as well. It’s a great way to give back to our community in a very tangible way.”

After obtaining a nod of approval from College leadership and campus security, Carson and Hannah completed a six-week training program.  Hannah demonstrated her unflappability and unflagging good spirits in the face of social tests like being bum-rushed by a crowd of people (she immediately cuddled into them), a huge plush banana in a wheelchair meant to stir feelings of fear (she went right up to it), people banging walkers and canes (she was unfazed) and the hardest hurdle – ignoring a tempting hot dog on the floor (she passed the treat by). In the end she walked away with pet VIP Certification through the Humane Society of Southern Arizona.

Since then, Hannah has become something of a celebrity around the College. “I’ve often thought she should have her own Cat Card,” joked Carson, who brings her sidekick with her on lecture days and during finals week. Sometimes Carson brings Hanna on impromptu hall walks to meet people, or hangs out in the courtyard to visit with students, faculty and staff. In the spirit of cross-college collaboration, Hannah has also worked her stress relieving magic at the College of Pharmacy, the College of Public Health and during the College of Medicine Tot Shots program, which provides free vaccines for underserved local children.

Hannah’s power to ease stress is palpable in the classroom setting. “She’s very intuitive,” said Carson. “She’ll go throughout the different sections of the class and she’ll gravitate toward one or two students who you can tell need soothing the most. She’s such a people lover and she loves to be loved. For a lot of students, that’s what they’ve said is the best part about her and what they enjoy the most, because she doesn’t just sit there. She literally will insert herself into your presence.”

The curriculum for “A Matter of Balance is designed for managing older adult’s concerns about fear of falling and what to do if they fall, such as how to get up safely from the floor,” said Taylor-Piliae. “But they don’t do specific exercises to help an older adult improve their balance.” That’s where Dr. Taylor-Piliae’s study comes in. Her team members of the Arizona Center on Aging,  includes M. Jane Mohler, PhD, associate professor, UA College of Medicine – Tucson and the Mel and Enid Zuckerman College of Public Health, and Nima Toosizadah, PhD, assistant professor, UA Colleges of Medicine –Tucson and Biomedical Engineering, will integrate its Dual-Task Balance Challenge (DTBC) intervention into the program. Designed to strengthen study participants’ sense of balance, the DTBC involves a series of ankle-reaching tasks that are both physically and cognitively challenging.

Partnering with El Rio Community Health Center, a non-profit organization dedicated to providing compassionate care to underserved populations, the study will enroll 24 community-dwelling older adults (60 years and older) who are at high fall risk. A 15-minute DTBC regimen (twice a week for four weeks) will be added to the participants’ AMOB training regimen. “By adding this very simple low-tech intervention to the existing curriculum, we hope to enhance both balance and attention and thus reduce the risk of falling,” said Taylor-Piliae.

“If we find that adding this intervention to the existing AMOB improves people’s balance, then we can test it further by seeking federal funding to test this on a wider scale,” said Taylor-Piliae. The ultimate goal would be to integrate the Dual-Task Balance Challenge intervention into the AMOB nationwide program. Taylor-Piliae points out that research doesn’t necessarily have to be high-tech to be innovative. In fact, the challenge’s low-tech structure makes it easy to be widely and quickly disseminated to AMOB’s network of volunteer lay leaders and master trainers.

A member of the Executive Leadership Council for the statewide Arizona Falls Prevention Coalition, Taylor-Piliae has a long-standing interest in fall prevention. In her last research project, she examined the effects of Tai Chi exercise on physical function, fall rates and quality of life among older stroke survivors. She garnered evidence that participants in the Tai Chi group had significantly fewer falls after the intervention. “My long-term research goal is to enhance community-based programs with readily accessible evidence-based solutions for preventing falls,” she said.

Sandy Kurtin’s mobile health application (mHealth app), MDS Manager™, shatters the stereotype that older patients are averse to technology. Together with The MDS Foundation, Kurtin developed The Building Blocks of Hope®, a digital and print tool to empower patients and caregivers living with MDS.  The next logical step was to create a mHealth app to allow patients and their caregivers to organize health information that will guide their health self-management. 

Primarily affecting older adults, Myelodysplastic Syndromes (MDS) are a bone marrow failure disorders diagnosed on average around age 73.  Though causes remain murky, radiation and chemotherapy for cancer can trigger the development of MDS, making it of prime concern to cancer researchers.  Low blood counts and the need for transfusion support are inevitable for most patients with MDS.  “Patients like to keep track of their blood counts to track their treatment’s progress,” said Kurtin about the initial inspiration for her project. “And we have invented a practical way to do this.”

“MDS Manager allows users to track their own lab results, bone marrow results, transfusions, treatments and any symptoms they may be having." ~ Sandy Kurtin, UA Nursing PhD Student

For Kurtin, MDS Manager™ is all about empowering patients to help themselves. “Understanding and engaging in your own care leads to netter health behaviors,” she said.  “We put so much of the onus on people to manage their own health without providing the tools and knowledge to be successful.  MDS Manager™ allows users to track their lab results, bone marrow results, transfusions, treatments, and any symptoms they may be having.” The app is also a great tool for better preparing patients to go to clinic visits to provide clinical input to health care providers.

“Patients don’t have to sit at a computer,” said Kurtin. “With a privacy compliant API interface, the app untethers people, allowing them to access and enter information wherever they are on a smartphone or tablet.” MDS Manager™ does not replace the electronic health record, but it allows patients to keep track of all their symptoms and treatments in one convenient portal. MDS Manager™ also provides links to vetted online information resources and will send alerts and other relevant links to the users based on their choices.  MDS Manager™ is available for download on IOS and Android formats.

To test the feasibility and usability, Kurtin, a nursing PhD candidate, is evaluating the use of MDS Manager™ to improve communicative health literacy and health self-management.  Of the 11 patients and caregivers (age 56-83) who participated in a pilot study, feedback was positive and their suggestions have been used to improve usability.  An expanded study using MDS Manager is the focus of Kurtin’s dissertation.  

Working with The University of Arizona Biostatistics department, and an mHealth app development company, Kurtin has been able to create a virtual platform for clinical research, allowing collection of both individual and aggregate data via the mHealth app.  A study web-site and Administrator dashboard allows for real-time monitoring of the data.  In the future, Kurtin hopes to develop similar mHealth apps with database connectivity and study web-sites for different conditions.

Find out more about MDS Manager™ and the planned study at: http://www.mds-foundation.org/mdsmanager