“There are still millions of smokers in the US. If you can help those people stop smoking, you’re going to greatly improve not only their health and wellbeing but also the health and wellbeing of people who are exposed to their secondhand tobacco smoke," ~ Judith Gordon, PhD

Dr. Gordon and her research team are currently seeking people who want to stop smoking to take part in an innovative study to test two approaches to help people quit. The Be Smoke Free study is funded by the National Center for Complementary and Integrative Health and seeks to test an integrative health approach to stopping smoking.

The Be Smoke Free program is provided by phone and text, with no in-person requirements. The program will provide six weekly sessions with a trained quit coach over the phone plus four weeks of nicotine patches or lozenges at no cost. Participants may also receive up to $100 for completing all study activities.  

“Because the Be Smoke Free program is delivered entirely remotely, there is tremendous potential to reach smokers wherever they are, whenever they’re ready,” said Dr. Gordon. “Plus, we provide robust support to smokers who are ready to quit for good.”

People interested in learning more about the Be Smoke Free program can visit the project website at: https://besmokefreestudy.org, email besmokefree@arizona.edu, or call 520-621-0458 for more information or to enroll in the program.

“Israel stands out because it’s an innovation hub. Also, they have an integrated health care system that capture the data at the ecosystem level. We considered other countries as well but after we evaluated, we concluded that Israel was the best place to visit," ~ Shu-Fen Wung, PhD, MS, RN, ACNP-BC, FAAN

Drs. Wung, Roveda, and John Paul SanGiovanni from UArizona and Dr. Tavakolian from the University of North Dakota served on the C2SHIP-Israel delegation to learn more about the country’s healthcare innovations in care delivery and healthtech to help evaluate their suitability for introduction into United States markets. “We wanted to help their industry, but on the academic level we were establishing a strong collaboration between our universities and the top universities and institutes in Israel,” Dr. Wung says, noting that the bond could allow the collaborators to apply for funding together from the National Science Foundation (NSF), private foundations and individual donors interested in promoting in-home health care delivery.

The trip, which took place between September 8-18, brought the UArizona representatives to several innovation hubs, including Ichilov Medical Center. “The IMed works closely with healthcare professionals to develop technology that turns unmet needs into solutions,” Dr. Wung says. In addition to the advanced seamless hospital admissions technologies, one innovation that particularly impressed her was the 3-D printing technology to precicisely develop patient-specific custom medical implants for surgeries. “They’re able to anatomically map out one’s body parts, taking into consideration things like tumor mass and topology  to cause minimal destruction, in creating individualized orthopedic structures,” she says. “It was quite eye-opening how strong they were in innovation.”

Additionally, Dr. Wung and her colleagues toured Israel’s biggest insurance company, MaccabiHealthcare Systems, which has a strong clinical research division with connected health data and capacity for large-scale prospective data archiving and access for efficient analysis. They also visited the Holon Institute of Technology, which, she says, is the most relevant to nursing education and her research. “They’re also working on innovative teaching curriculum,” she says. “Not only are they training engineers but they’re immersing medical education into their training, with a goal of developing engineers who are well-versed in health technology.” The institute is slanted toward medicine, Dr. Wung says, but she sees it as an opportunity to bring a nursing voice to the discussion  if the University of Arizona and the Institute partner in submission of education grants.

Dr. Wung was particularly impressed with the Bezalel Academy of Art and Design, which, unlike traditional art schools, has a focus on art and design that can impact healthcare settings, including music created to decrease stress and evaluating technology for better user experiences. “I’m familiar with using cognitive psychology to evaluate usability,” Dr. Wung says, “but using art and design is a promising future direction.  It was quite fun to see the artful projects they were working on that also incorporate AI in the design of healthcare technologies.”

During her time in Israel, Dr. Wung was impressed with how front and center technology was to the different companies and institutions she toured. She returned to Arizona excited about the new partnerships and eager to see how the nursing field could contribute to future innovations.

Currently, Dr. Wung and her colleagues in the College of Engineering and College of Agriculture & Life Sciences are meeting frequently with their Israeli partners. Drs. Wung and Roveda have also submitted a training grant that will be used to train students in new health technologies. “My goal is to make sure that any technology that’s developed has clinical relevance. And that it's user-centered, meaning they can’t just develop anything without considering who is using it, whether it’s a clinician, a patient, the family, or the caregiver. The goal is to make sure that the technology used will improve the quality and safety of their care.”

Dr. Wung is excited about how open and innovative the Israeli companies are, and how energetic they are about pushing care technology to the next level. “They do a good job of infusing disciplined knowledge into their design and viewing the technology as part of the daily environment. That’s really important because the U.S. is moving toward a holistic health concept of how your body and the environment are interconnected.”

Cognitively-Based Compassion Training (CBCT) was developed at the Center for Contemplative Science and Compassion-Based Ethics at Emory University. Unlike other meditation programs that focus solely on mindfulness, CBCT is focused on how an individual interconnects with other people, building an ethos of compassion and well-being for the person and for others.

“The idea for this project came from our earlier work with Cognitively Based Compassion Training with breast cancer survivors several years ago,” Dr. Pace says, adding that researchers including Terry Badger, PhD, RN, Eleanor Bauwens Endowed Chair and professor in the UArizona College of Nursing and UArizona Cancer Center member, have studied the importance of supportive partners for the well-being of cancer survivors for years.

“There is neuroscience research showing that people who meditate over time can actually change their brains and the way their minds work," ~ Thaddeus Pace, PhD, UArizona College of Nursing associate professor

“We wanted to expand our use of Cognitively-Based Compassion Training for survivors and partners together,” Dr. Pace says.

Study participants will attend weekly CBCT sessions or Cancer Health Education classes for 10 weeks. Both groups will receive the training online in a format similar to internet-based group exercise classes. Survivors and their supportive partners can participate from anywhere with an internet connection and a computer or large tablet.

While previous studies utilizing meditation have been done in person, the pandemic inspired Dr. Pace and his colleagues to look at a new model utilizing video conferencing systems to expand access.

“The pandemic has made everyone more comfortable with using systems like Zoom, and we started to think it would be really interesting to create a program through Zoom,” Dr. Pace says. “We conducted a pilot study with survivors and partners that worked relatively well, so this project is a continuation of that on a larger scale, allowing survivors and supportive partners to participate coast to coast.”

“The pandemic posed the great challenge of learning how to successfully deliver compassion training online,” says Lobsang Tenzin Negi, PhD, executive director of the Center for Contemplative Science and Compassion-Based Ethics at Emory University. “What started as a challenge quickly became a blessing. We have been able to share on a larger scale and offer to more people than ever before. Collaborating with UArizona Nursing on this novel research project will allow us to combine new insights with previous studies and learn even more about how to benefit cancer survivors and the supportive partners.”

Interested in participating in the study? Click here.

This research is supported by the National Cancer Institute, a division of the National Institutes of Health (R01CA264047).

“This grant provides the opportunity to expand wearable technologies into community engaged research for cancer survivors in a unique way and brings together an interdisciplinary team of experts," ~ Meghan Skiba, PhD, MS, MPH, RDN

What was the inspiration for this new intervention?

Gardening has been shown to promote cancer preventive behaviors for cancer survivors and melanoma is a cancer control priority in Arizona.  This intervention was inspired by the uniqueness of our area, including the arid southwest environment, five distinct growing seasons, the needs and limited resources for melanoma survivors, and expansive Cooperative Extension office and community gardens across the state that show promise for scaling the intervention. Prior to submitting this grant, stakeholders were engaged to adapt an existing evidence-based intervention, Harvest for Health, in a meaningful way to build capacity and sustainability. Adapting and testing, prior to dissemination and implementation, of existing effective interventions to meet the needs of diverse populations prevents us from redundancy in research.

What will the structure of the intervention be?

Harvest for Health Together Arizona (H4H2-AZ) is an adapted multimodal mentored community garden intervention. Thirty diverse melanoma patients will be recruited to participate in a six-month intervention to grow two seasonal vegetable gardens. Participants will be matched to a ‘near peer’ Master Gardener and provided with a lease for a shared garden plot through the Community Gardens of Tucson with necessary gardening supplies including seeds and sun protection. Following a five-module handbook custom designed for H4H2-AZ, participants will work together with their Master Gardener to prepare, plant, harvest, and preserve their garden. Additionally, Master Gardeners will deliver workshops that align with module content. The innovation of this intervention comes from collecting real-time UV exposure and providing feedback to participants while in the garden. Diet, physical activity, and quality of life will be measured before and after the intervention.

What is particularly important about the research you’ll be undertaking?

This is the first study designed to improve supportive cancer care by integrating melanoma patients with existing community gardening networks in Pima County and includes wearable UV sensors and just-in-time feedback to evaluate impact on cancer preventive health behaviors -- including diet, physical activity, energy balance, and UV protection. Our findings from this study will provide important feasibility and acceptability data to inform future large-scale interventions. This work will also show the benefits of application of sensor technologies in behavioral interventions to provide objective outcome data on modifiable health behaviors.

Tell us more about the wearable technology that will be in the works with the help of Shade.

We will be integrating wearable UV sensors, or dosimeters, to monitor and provide just-in-time feedback of UV exposure to participants aiming to reduce sunburns and improve sun-protective behaviors.  The reusable UV sensors are made by Shade and come with a complementary mobile app where participants can securely share their data with us as well as see their cumulative and instantaneous UV exposure. This sensor technology has been previously used at the University of Arizona but we will be among the first to integrate it in a behavioral intervention for melanoma patients.

How did you gather your partners for this project?

The partners on this project are community leaders and experts already doing important work in our community and we hope this intervention will elevate it. The partnerships were built from conversations with members of the UACC Skin Cancer Institute, UArizona Cooperative Extension, and original H4H investigators. Dr. Delaney Stratton is a cutaneous oncology nurse practitioner brings important clinical perspective and partnerships and Dr. Hall brings in key stakeholders for environmental sustainability. In particular, Parker Filer, an extension agent with the Cooperative Extension has been a key player establishing the community connections necessary for the intervention’s success. Parker has assisted with engaging the Community Gardens of Tucson as well as the Pima County Master Gardeners.

How do you hope the results of this research improve cancer preventive health behaviors among melanoma survivors?

UV exposure is the primary modifiable risk factor for melanoma, but melanoma is also an obesity related cancer; survivors of which may benefit from adhering to current cancer prevention guidelines. H4H2-AZ promotes cancer preventive health behaviors and emphasizes sun safety, which is often absent in gardening interventions but is important for melanoma prevention and survivorship. Currently, there are limited active supportive lifestyle interventions for melanoma patients in Arizona, which makes our multiple health behavior approach fill a current need in the population. H4H has previously shown improvements in vegetable intake and physical health for cancer survivors, and we anticipate similar findings from H4H2-AZ

Can you share any details about the larger extramural grant application you’re planning for next year?

We will build on the partnerships established from this pilot and will also engage the Arizona Melanoma Task Force in scaling the intervention. H4H2-AZ is intervening on multiple levels, including the intrapersonal, interpersonal, community, and organizational, therefore we will be submitting a grant to further study optimization of the delivery of H4H2-AZ and distal outcomes, expanding the program across all AZ counties. Findings from this intervention will provide preliminary data to support an extramural grant application that has been a work in progress as part of my participation as a fellow in the 2022 cohort of the National Cancer Institute’s Multilevel Intervention Training Institute.

Big picture, where do you hope this work will lead?

We anticipate that this work will lead to sustainable connections between clinics and community to promote the health of cancer survivors and their families in Arizona. The big picture is a collage of individuals gardening in their neighborhoods and building networks of support to reduce melanoma incidence and mortality.

Learn more about Dr. Skiba’s project by visiting the Healthy Harvesters program page.

“I focus on pregnancy, on reproduction, and on the placenta in particular, as an environment that’s connected to the past and the future in terms of health," ~ Julienne Rutherford, PhD, John and Nell Mitchell Endowed Chair for Pediatric Nursing

Dr. Rutherford comes to the UArizona from the University of Illinois at Chicago, where she was Associate Professor and Associate Department Head of Human Development Nursing Science in the College of Nursing. She has been a Robert Wood Johnson Future of Nursing mentor and has received numerous awards including: the UIC Researcher of the Year Rising Star in Clinical Sciences, American Society of Primatologists Legacy Award, National Academy of Science Kavli Foundation Fellow, the American College of Nurse Midwives Excellence in Teaching Award, an NIH Loan Repayment Program Award, and the Teaching Recognition Program Award and Award in Teaching Excellence both from UIC.

Dr. Rutherford is a biological anthropologist whose work integrates evolutionary theory with biomedical science. For 20 years, she has sustained a program of research exploring the intrauterine environment as a biosocial determinant of health. “I pull from several threads of biological anthropology and health sciences,” she explains, noting that her work centers on the dynamic intrauterine environment of the fetus and how lived experience of the mother across her own life course and even prior generations shapes that environment. “That drives not only pregnancy outcomes and fetal outcomes but really health across the life course for individuals,” she says. “I focus on pregnancy, on reproduction, and on the placenta in particular, as an environment that’s connected to the past and the future in terms of health.”

Dr. Rutherford’s current research focus is her “Womb to Womb” model of reproductive health and pregnancy outcomes in the marmoset monkey. Using data provided by the NIH-funded Southwest National Primate Research Center in San Antonio, Texas, Dr. Rutherford examines how different intrauterine conditions shape birth outcomes, growth and development, and even ultimately pregnancy outcomes of future generations. “We’ve shown in the marmoset that it is not a mother’s age or weight at the time of the pregnancy – the things we focus heavily on in human clinical contexts – that have the strongest impact on her pregnancy, but things that happened during her development, things she didn’t have any control over,” Dr. Rutherford said, explaining that the marmoset’s variable litter size provides the opportunity to study several factors. “If a marmoset female is born as a triplet or on the smaller end of birth weight, she is more likely to have worse pregnancy outcomes when she grows up. This gives us a lot to think about in the way we tend to blame mothers for their pregnancy outcomes, not taking into account their entire lived experience, in ways that contribute to disparities and injustices in maternal and infant mortality.”

As part of UArizona Nursing’s new Nurse-Midwifery program, Dr. Rutherford will be a passionate and knowledgeable player. She hopes to help students contextualize pregnancy as a process beyond anatomy and physiology and show how the world around us can shape those experiences negatively through stress and discrimination, but also positively through social, systemic, and structural kinds of support. In addition to teaching the anatomy and physiology of pregnancy and birth to midwifery students for the past decade, she has direct experience with midwifery from giving birth to her daughter – an experience she calls life-changing. “I was already studying the biological process of pregnancy, but experiencing it in a midwifery model, being cared for as a whole person, was really incredible,” she says.

As the John and Nell Mitchell Endowed Chair, Dr. Rutherford will continue her research on the intrauterine environment, which focuses on more than the early postnatal life to include infancy, childhood, adolescence and early adulthood. “I’ll be developing my own program of research, as well as supporting other faculty and PhD students to develop synergies of work that encompass a life course approach to health in thinking about pediatric research, and ultimately pediatric care,” she says. For example, one area of research she is excited to explore more deeply at UArizona is the underlying biological mechanisms of postpartum hemorrhage. “Excessive bleeding at birth is one of the leading causes of maternal mortality globally,” Dr. Rutherford notes. “There are many kinds of hemorrhages and likely many pathways, but we really know very little about how the risk develops early in pregnancy. I am so excited about the intersections between basic science and clinical care that I and other faculty in the College of Nursing have in this area and can’t wait to start collaborating!”

She was drawn to UArizona Nursing for numerous reasons, including its focus on collaboration and innovation, but also its commitment to engage in honest conversations around equity, diversity, and inclusion. “And, I would add, justice,” she says, pointing out that academia broadly, and nursing in particular, tend to be very white fields. “We don’t match the communities that we’re serving through our scholarship and through our clinical practice. Coming from one of the most diverse universities in the country, these are really important issues to me, so that’s hugely meaningful to see them being so openly engaged with in the UArizona College of Nursing.”

“This recognition affirms my commitment to address health equity by continuing to foster relationships between underserved communities, academia, and practice. I’m grateful for my mentors and UArizona Nursing for supporting my passion to reduce health disparities and promote health equity by evolving a nursing workforce in partnership with diverse communities," ~ Timian Godfrey, DNP, APRN, FNP-BC

Dr. Godfrey, teaches in the College’s advanced practice DNP-FNP program, has more than 18 years of health care experience within the fields of hospice, gerontology, emergency medicine, medical/surgical, telemetry, cardiac intensive care, pain management, and orthopedic spine surgery. In addition to being faculty with UArizona Nursing, Dr. Godfrey is advanced practice clinician with TribalHealth, a healthcare leadership company that works with government and tribal health programs.

“It is a tremendous honor to be selected as a Fellow in the American Academy of Nursing,” Dr. Godfrey said. “This recognition affirms my commitment to address health equity by continuing to foster relationships between underserved communities, academia, and practice. I’m grateful for my mentors and UArizona Nursing for supporting my passion to reduce health disparities and promote health equity by evolving a nursing workforce in partnership with diverse communities. As a Fellow in the Academy, I hope to strengthen my capacity to provide a rich future-oriented perspective on what is possible, practical and important to having a diversified nursing workforce and healthy, sustainable working and learning environments that are enrichingly diverse and inclusive.”

“As the American Academy of Nursing’s President, it gives me great pride to announce the largest class of Fellows since the organization began nearly 50 years ago,” said Kenneth R. White, PhD, RN, AGACNP, ACHPN, FACHE, FAAN. “At a time when investments in, and policy to address, health equity, innovation, and access are paramount, the Academy is thrilled to welcome these dynamic and courageous nurse leaders who will support our collective vision of healthy lives for all people. Induction in the Academy is a powerful moment in a nurse’s career. When we gather this fall, to award the Fellowship credential, I look forward to celebrating each Fellow’s incredible accomplishments that have improved the well-being of communities across the globe.”

Through a competitive and rigorous application process, the Academy’s Fellow Selection Committee, which is comprised of elected and appointed Fellows, reviewed a record number of applications, representing a 30% increase from the previous year, ultimately selecting the 2022 Fellows based on their contributions to advance the public’s health. Induction into the Academy is a significant milestone in which past and current accomplishments are honored by their colleagues within and outside the profession.

“I am excited by the opportunity to collaborate with Eller on this interdisciplinary project and connect individuals with various skills to inform healthcare delivery and ultimately improve health of Southern Arizonans and related economic impacts. It will highlight the interconnectedness of technology, health, and economy in Southern Arizona," ~ Meghan Skiba, PhD, MS, MPH, RDN

The project, which will span the fall 2022 semester, will utilize public datasets and GIS mapping to characterize and predict mHealth usage specifically among Southern Arizonans. The hope is that the results from this research – including a white paper on the MAP dashboard that will be publicly accessible to anyone to inform their programs and policies -- will support future telehealth innovations in healthcare delivery in Southern Arizona. Once the primary research is published, a webinar hosted by Eller will present the results and engage with community members and the MAP advisory board.

Can you tell us about the genesis of this project?

This project originated out of filling a need for Southern Arizona through Eller’s MAP Dashboard. The MAP Dashboard site provides Southern Arizona with information on social and economic indicators in our local community that can inform programs and policies. As a researcher, I have seen a clear gap in our development of telehealth interventions and our understanding of who can access and reach these interventions, through this project we hope to create a bridge that will improve health locally.

Can you tell us about the roles that mHealth have played up to now in Arizona health care?

Currently little is known specially about mHealth use, including ownership and use of smartphones, health-related mobile applications, and wearable devices specifically for Southern Arizonans and it has been unclear if national trends are accurate for our unique environment. In the setting of COVID-19, telehealth utilization rapidly accelerated, and now more healthcare services are available through mHealth.

How will the results from this research support future telehealth innovations in healthcare delivery in Southern Arizona?

Completion of this project will provide guiding data and insights that can be used by University of Arizona researchers and community stakeholders in Southern Arizona.  This data will help with the implementation of novel approaches to address social determinants of health and chronic disease prevention using mHealth and connect academia, industry, clinician, non-profits, healthcare organizations, and public health professionals to develop precision mHealth. My hope is that the results from our study will be used to support the design of multilevel and holistic telehealth interventions.

How will you select the Nursing student and Geography student who will take part in the project?

A PhD student in Nursing, Carlie Felion, was connected with the project through a graduate course during the grant writing process and was involved in the submission process. As a Co-I on the project, she helped develop the proposal and throughout the project period she will support interpretation and communication of our results. Carlie was a great match for this project due to her interest in digital health and experience as a family and mental health nurse practitioner. For Geography, I am working with Andrew Grogan, the assistant director of the UArizona’s Geography Information Systems Technology program to develop a paid internship opportunity as part of their course requirements as well as reach out to their alumni network to match interests and skills to analytical needs. Andrew has been a tremendous ally in the realization of this project.

Can you share your hypothesis as you approach this project?

Our hypotheses are that mHealth use will have increased overtime in Southern Arizona, that social determinants of health will influence who is using mHealth and that mHealth users in Southern Arizona will engage in more chronic-disease preventive behaviors – for example, eating fruits and vegetables, being physically active, avoiding alcohol and smoking -- resulting in higher perceived health status.

Once this project is completed, are you contemplating next steps in the future?

After this project is completed, this information can be used to develop tailored mHealth multilevel interventions -- those that include the individual and their connections -- that considers and addresses social determinants of health to reduce health disparities. Engaging with community partners, this information may further shape local policies related to access of technology and healthcare. Future research can explore the relationships of mHealth and social determinants of health on cancer screening behaviors and chronic disease burden.

“We want to preserve quality of life and living well as long as possible. We know that uncontrolled and undertreated hypertension has a deleterious effect on people’s organs including the brain, even in the absence of stroke. If we can protect people's ability to think and remember, they have the option of staying independent," ~ Kathleen Insel, PhD, RN, Interim Dean and professor, UArizona College of Nursing

The National Institute of Nursing Research-funded project, “Digital Technology to Support Adherence to Hypertension Medications for Older Adults with Mild Cognitive Impairment,” is led by Dr. Insel and co-principal investigator Raksha Mudar, PhD, associate professor of speech and hearing science at the University of Illinois.

The goal is to adapt and evaluate the digital health intervention Medication Education, Decision Support, Reminding and Monitoring System (MEDSReM^©). It is designed to improve hypertension medication adherence and support self-management of hypertension medication for people with mild cognitive impairment.

MEDSReM changes the medication-taking process from one that is dependent on prospective memory to one more dependent on associative processes, which are relatively well preserved in aging and may be more available for people with mild cognitive impairment.

“The foundation of MEDSReM is very different from the foundation of medication-reminder apps that are available in the marketplace,” Dr. Insel said. “This is not a simple reminding app. You've got to encode the need to take the medication, store it cognitively in memory, and importantly, remember to do it at the time it needs to be done. You also need to pay attention to taking the medication, which becomes more difficult because it becomes a habit, so the act of having taken the medication today may not be well remembered. Therefore, you need to be able to check to see if the medication was taken as intended.”

The researchers will work with Ephibian Inc., a software development company with offices in Tucson, Arizona, Phoenix and Denver, to adapt the MEDSReM app and web portal.

“Previously we tested this as a behavioral intervention, and we improved medication adherence 36% among older adults who were taking at least one daily high blood pressure medication,” Dr. Insel said. 

“An important aspect of this study is that we will adapt the app by getting input from people with mild cognitive impairment and their care partners,” said Dr. Mudar, who studies the effects of normal cognitive aging and mild cognitive impairment on functional abilities. “We want to learn how to change MEDSReM to suit the needs of people with mild cognitive impairment. We will conduct multiple rounds of usability testing to optimize the app before we examine its efficacy to support medication adherence.”

Drs. Insel and Mudar will work with an interprofessional team that includes Jeannie Lee, PharmD, BCPS, BCGP, FASHP, associate professor in the UArizona R. Ken Coit College of Pharmacy, Matthew Grilli, PhD, associate professor in the UArizona College of Science’s Department of Psychology, Mindy Fain, MD, co-director of the UArizona Center on Aging and professor and interim chair of the Department of Medicine in the UArizona College of Medicine – Tucson, and Josephine Korchmaros, PhD, director of the Southwest Institute for Research on Women in the UArizona College of Social and Behavioral Sciences.

“Essentially, we want the prototype we’re building to be able to immerse students in a realistic environment where they can practice solving problems and the environment can also assess and provide feedback," ~ Janine Hinton, PhD, MN, RN, CHSE

“They’re making great progress with creating this system,” Dr. Hinton says. “When this all gets woven together, we’ll have the foundation to be able to continue building on that work and also going after larger funding opportunities.”

The ISE prototype will ultimately be able to immerse students in a realistic environment where they can practice solving problems and receive assessments and feedback about their performance. “We don’t have a mind-reading system, so this is the closest we can get,” Dr. Hinton says, noting that many years of research lie ahead for the program.

After the initial building blocks have been laid, student responses will be compared to the results of experts solving particular problems using the Artificial Intelligence (AI) resources. “AI resources learn how they do it and then you can take someone who is a novice or an advanced beginner and have them try to solve the same problem,” Dr. Hinton says. “The AI agent should be able to find the difference and also provide some hints and clues to help the performance of the novice.”

In the end, Dr. Hinton aims to integrate the program into everyday student training, which will also be a boon to the faculty who typically take part in the student assessments. “We’re hoping that in some ways the system will be more objective, and that it will provide an efficient and eventually cost-effective way for students to learn in a formative assessment type approach and for summative assessment,” Dr. Hinton says. Currently, assessing nurse performance during a training can take up to 10 experts who review the recorded simulation test and render a fair judgement of the student’s performance. It’s an expensive approach that requires extensive training and stamina. “AI doesn’t get tired, it just needs electricity,” Dr. Hinton says. “If it’s set up well, then we can utilize the expertise of those faculty members for training and addressing things that the AI and the virtual coach can’t.”

Dr. Hinton hopes the Intelligence Simulation Environment prototype will go on to have an even greater impact of patient care than helping train students hone their problem-solving skills. “We have lots of problems in health care,” she points out. “It’s complex, it’s so challenging, and what we know about it changes.  We have so many mistakes and we’re expecting people to just be amazing and brilliant out of the gates long term and just be able to solve these problems.”

Currently, medical errors are the third leading cause of death in healthcare settings. With enough time and effort, the ISE may be able to put a dent in that troubling statistic. “If it works really well and there’s a way to transfer it to actual practice then maybe the nurses and healthcare providers of the future will be wearing little headsets or eyeglasses and they’ll take their little AI buddy with them,” Dr. Hinton says.

The Intelligent Simulation Project was made possible in part through funding from CUES, the Center for University Education Scholarship at the University of Arizona. Any views, findings, or recommendations hereby expressed are those of the author(s) only.

“We have a small but mighty faculty. Faculty in the College of Nursing are very productive in securing NIH funding, as well as other types of extramural funding. The Blue Ridge rankings don’t even tell the whole story," ~Jennifer Montjoy, UA College of Nursing PhD Student

Montjoy’s research joins a growing field. MDMA, for example, is currently in phase three clinical trials with a likely outcome of the Food and Drug Administration approving clinical use for post-traumatic stress disorder (PTSD). “No one is suggesting providers’ prescribe ecstasy to take at home for recreational use,” she says. “This work is very much about the ecology of the healing space and specialized for licensed clinicians, including nurses. Johns Hopkins has been investigating psilocybin since the early 2000s. This field has recently begun to gain traction and legitimacy with research being published in peer reviewed journals.”

Montjoy is quick to point out that most of the clinics that offer ketamine as a treatment for depression as an intervention are intravenous (IV) infusion and are predominantly being managed by anesthesiologists, pain management, and emergency medicine clinicians. “These settings are not incorporating psychotherapy or mental healthcare clinicians,” she explains. “It’s a very medicalized approach, which is really different from KAP, the focus of my dissertation project.”

In addition to her PhD work, Montjoy runs Tucson-based Resilience Behavioral Health Solutions, which she founded two and a half years ago to provide non-IV ketamine-assisted psychotherapy and offers AANP-accredited 4-day KAP trainings for licensed clinicians and providers. Much of the data in her dissertation project were measures collected pre-and post-KAP treatment from clients Montjoy previously worked with in her practice.

Did Resilience Behavioral Health Solutions help influence your research direction?

I worked for UArizona’s Counseling & Psych Services (CAPS) for 2 years as I opened Resilience in Tucson. I was following the research around ketamine and I was pretty naïve. I didn’t know much about ketamine in terms of subjective effects or recreational use. I wanted to offer ketamine through Resilience but I knew I needed more education about administration, and about the medicine itself. When I started looking at certification programs, that’s when I learned ketamine induces a non-ordinary state of consciousness. I thought, what a missed opportunity for more in-depth healing that could be provided through psychotherapeutic support/facilitation.

What distinguishes your research on this subject from some of the other studies going on in this field?

For my dissertation I’m providing analyses on retrospective treatment-resistant depression and post-traumatic stress disorder clinical outcomes – and exploring whether potential correlates such as childhood adversity and self-transcendence influence outcomes, so it differs in methodology and focus. The primary difference, the ‘why,’ is that approximately 55% of folks with treatment-resistant depression have co-occurring PTSD. There is gap in current ketamine research measuring and analyzing trauma symptom severity in currently available literature. What’s more, we are experiencing an epidemic of suicide endemic in veterans, suicide is also the second cause of death in Americans 10 years and older. It’s really disturbing and exemplifies the need for additional and efficacious interventions.

I think what also sets my focus research focus apart is that is that it’s looking at childhood adversity as a variable that may influence outcomes. We’re collecting measures for three things: One, there’s not much research around ketamine (KAP) and PTSD; two, inclusion of childhood adversity as an exploratory variable; and three, inclusion of self-transcendence as a measure. I’m using a measure developed by one of my mentors, Dr. Pamela Reed. Dr. Reed’s self-transcendence scale may be a good fit for looking at the existential experience in relation to psychedelic medicine, an important aspect of the human experience and our suffering that’s not typically assessed or measured in ketamine research.

Tell us about your hypothesis for your dissertation.

The purpose of my dissertation project is to explore whether there is a reduction in depressive and PTSD symptom severity post-ketamine assisted psychotherapy (KAP). I am hypothesizing that self-transcendence will be moderate to high post-KAP, based on Dr. Reed’s theory of self-transcendence. The second aim is to elucidate any associations between self-transcendence and PTSD symptom severity and self-transcendence and depression severity post-KAP, and investigating if there’s a decrease in trauma-related symptoms, whether this correlates to a higher self-transcendence score between participants who reported history of childhood adversity compared to participants without or lower childhood adversity measurements. We’re trying to tease out who really might benefit from this therapy.

What changes do you envision this work making in terms of actual practice?

There’s still a lot of stigma around using ketamine psychotherapeutically, so I want to disseminate my findings in a language that is considered valid and reliable in the mental healthcare and medical communities. Most of the data published around ketamine are biomedically focused, and regard the psychedelic experience as an unwanted or undesirable side effect; I'm suggesting these subjective experiences during the psychoactive phase post-ketamine administration may be helpful when provided or facilitated by well-trained, specialized clinicians. At a minimum, I'm suggesting that the psychedelic or non-ordinary state induced by ketamine and other medicines merit further investigation; we need to listen to our patients, and nurses are particularly adept at this in clinical practice and in research.

What are your plans once you’ve earned your PhD this semester?

Long-term, I'm planning to continue to collect and disseminate KAP findings and to continue to provide specialized accredited training for licensed clinicians. Last year, I founded the 501(c)(3), the Transpersonal Research Institute of Psychotherapeutic Psychedelics (TRIPP), whose mission is to provide clinical research mentorship in the psychedelic sciences to female and BIPOC scientists and clinicians, and to expand KAP access to underserved peoples in southern Arizona. Whatever unfolds, I will be forever grateful for my time at UArizona’s College of Nursing and to my mentors, Drs. Thaddeus Pace, Kathleen Insel, and Pamela Reed.