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

What drew you to a career in nursing?

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

What attracted you to the UArizona College of Nursing?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guided imagery is a proven method that uses your imagination to help you deal with stressful situations, including social isolation. This technique is also called visualization. But Guided Imagery includes more than just visual images. Guided Imagery involves imagining sights, sounds, tastes, smells, tactile senses, and emotions in a particular situation.

Here’s a sample of Guided Imagery to help you experience how guided imagery works: Imagine you are in a kitchen with a bowl of lemons on the counter. You see their bright yellow color and distinctive shape. You reach out and select a ripe yellow lemon. You feel the weight of the lemon in your hand as you slide your fingers over the dimpled waxy skin. Now, put the lemon down on the counter, pick up a knife and carefully cut into the lemon. You see the yellow flesh and the juice dripping out onto the counter. You smell the sharp citrusy aroma. You cut a slice and put it in your mouth. Bite down on the tart, juicy slice, and let your mouth fill with the tangy juice.

Guided Imagery can help alleviate stress associated with social isolation. You can create a vivid scene in your mind of a place or activity that you find relaxing, like sitting on a long, sandy beach listening to the waves or walking along a desert trail on a sunny day and hearing birdsong. These scenes can take you anywhere you want to go as well as relax you. The possibilities are endless and can be personalized just for you.

The trick to making the most of Guided Imagery is to create a very detailed “script” describing your favorite scenes or activities. Add lots of evocative language (think adjectives like “clear blue sky” or “shiny, smooth green leaves”) and include all your senses, especially slow, deep breaths and relaxed muscles, and feelings of happiness and well-being.

After you’ve created a Guided Imagery script that you like, record it on your phone or ask a friend or family member to record it if you don’t like the sound of your own voice! It's easy to send scripts and audio files by email or text. You can create as many audio files as you like.

Listen to one audio file several times each day until you can “automatically” recall the images vividly. The more vivid the imagery, the more effective it will be at reducing stress. Then, you can move on to the next file. If you can automatically recall the Guided Imagery, you can use it even if you don’t have access to the audio file. 

When you are feeling isolated or stressed, listen to or recall your Guided Imagery. Stroll through beautiful village, hike up a mountain, sail on the ocean. Guided Imagery can take you on infinite, enjoyable journeys!

Guided Imagery can help alleviate stress associated with social isolation. You can create a vivid scene in your mind of a place or activity that you find relaxing, like sitting on a long, sandy beach listening to the waves or walking along a desert trail on a sunny day and hearing birdsong.

Tips for Creating your own Guided Imagery

1. Describe the scene in detail:

• What do your surroundings look like?
• Who are you with?
• What sounds do you hear?
• What scents do you smell?
• What do you feel on/in your body or what do you touch?
• How do you feel/what emotions are you experiencing?

2. Write and edit your “script” using lots of descriptive words.

• Use lots of adjectives and adverbs.
• Think about colors and textures.
• Focus on happy and calm emotions.

3. Record your script as an audio file on your phone.

• Each type of phone is different, so if you need help recording the file, do an Internet search for your particular model of phone.
• If you like, pick some relaxing music and play it while you record your script.
• Ask a friend or family member to record the script for you.

"I love helping people, but I’m at a point in my career when I feel like I can give back to my profession. And the way to give back to my profession is really to make a difference in research and teaching. It’s validation that even when the nights get long and circumstances get challenging, to keep going.” ~ Christine Platt, first-year PhD student

“Because of my intensive care and pediatric clinical experience,” Platt says, “the state really liked to place children with special needs and medical conditions in my home, because they knew that if something went wrong they had someone with the training to handle that situation.” Platt -- who has had more than 14 young children placed in her care over the years -- is intimately familiar with the challenges faced by kids with special needs and the families who care for them.

As a part of the community of families raising foster or adoptive children with special needs, from learning disabilities to severe physical disabilities, Platt saw how foster families grew confidence and strength when things went right, but she also saw how painful results could become when families lacked the resources, education or training to take in a child with special needs. The desire to improve outcomes for this population was the genesis of Platt’s award-winning research.

Her first step was to examine whether what she was seeing in the community – children with disabilities jumping from foster family to foster family and ending up spending more time in the system – was an accurate representation of the facts. An investigation of data and trends revealed this was true. Platt’s second step was to examine the successful resources and protective factors that help foster families provide a stable environment for these unique kids.

“My research will focus on qualitative information and quantitative data to see what help is available, and then look at interventions, whether through training, education, or even political action, to give these kids a real fighting chance and improve the system for them,” Platt says.

Although she has many months of work ahead of her, she theorizes that the right combination of training and education will be key for foster family success. Platt also plans to take a holistic approach with her research, examining how the situation affects not just the foster parents and the foster child, but also any other siblings that may be in the home. “The foster parents may be receiving education,” she says, “but what preparation do the kids in the home have to be able to help out and incorporate a foster child into their home and give them the love and the stability that they need? I want to look at not just the caregiver preparedness, but also the family preparedness.”

That preparedness, Platt theorizes, will lead to improved outcomes for this vulnerable population. With everything stacked against them, she believes her research can ultimately improve their health, not only for the period they spend in state custody, but for their lifetime.

Asked about her feelings about being awarded WIN’s New Researcher award, she expresses pride in being recognized by her peers. “It tells me that what I’m doing matters,” she says. “I love research. I enjoy writing. I love helping people, but I’m at a point in my career when I feel like I can give back to my profession. And the way to give back to my profession is really to make a difference in research and teaching. It’s validation that even when the nights get long and circumstances get challenging, to keep going.”

Christine Platt will receive her award at the 2020 WIN Conference Awards Lunch, which will be held on Thursday, April 16. 

"The INCATS program expands our capacity to partner with our American Indian communities in the shared mission to increase the number of skilled, competent, caring, compassionate Wildcat nurses who will serve as role models and health-care leaders in their tribal communities.” ~ Michelle Kahn-John, PhD, RN, PMHNP-BC, GNP

“I am most grateful to Drs. Kahn-John, Koithan and Shaver for their creative approach to increasing the number of undergraduate and graduate Native American nursing students in the College of Nursing,” said Ida M. “Ki” Moore, PhD, RN, FAAN, dean of the College of Nursing. “With support from this highly competitive national IHS award, the INCATS program will support our efforts to build new partnerships with tribal communities and to increase the diversity of the next generation of nursing leaders.”

A cooperative agreement with the IHS Division of Health Professional Support, INCATS will fund and support nursing career transition and advancement of American Indians and Alaska Natives interested in entering or advancing their nursing careers. It also will create new pathways for associate degree nurses to advance their careers and build new tribal-academic practice collaborations that expand the Native American workforce prepared to improve care of native populations.

“With much excitement, we begin 2020 by supporting five American Indian/Alaska Native scholars on their academic journeys,” Dr. Kahn-John said. “The goal of the INCATS team is to offer an inclusive, safe, supportive and enriching academic experience for every student who attends the UArizona College of Nursing. The INCATS program expands our capacity to partner with our American Indian communities in the shared mission to increase the number of skilled, competent, caring, compassionate Wildcat nurses who will serve as role models and health-care leaders in their tribal communities.”

All of the tribal health-care systems in Arizona's 22 federally recognized tribes/nations report extreme nurse shortages, particularly American Indian registered nurses. Leaders report the most critical needs are RNs who can move between acute and primary care and nurse practitioners in family and psychiatric/mental health specialties.

“The University of Arizona College of Nursing’s firm commitment to inclusive excellence is building a better world for our students and our state,” said UArizona President Robert C. Robbins, MD. “The INCATS program will help create a more diverse and culturally competent nursing workforce primed to serve our community partners.”

Dr. Kahn-John and her team will develop and implement the INCATS program in collaboration with their tribal community partners throughout Arizona as well as other tribal partners in South Dakota and Montana.

To be eligible for the INCATS program, scholars must be American Indian or Alaska Native, enrolled at the UArizona College of Nursing as a pre-nursing or nursing student, and must be nominated by a community partner, such as a tribal clinic, college or organization. INCAT Career Advancement Scholars will receive tailored educational plans to achieve their professional goals, mentorship and academic navigation to ensure best outcomes for each scholar and each tribal community partner. These efforts will result in additional BSN-prepared RNs and advanced-practice American Indian and Alaska Native NPs (nurse practitioners) to practice in tribal facilities.

In addition, the grant supports flexible career-advancing degree pathways for American Indian and Alaska Native RNs with community college degrees through an RN-MSN program in clinical systems leadership. Interactive continuing professional education resources will be created and shared with tribal partners to support and enhance clinical competence and improve the quality of care delivered to tribal communities. College leaders note partnerships with tribal community colleges will foster greater capacity to support tribal and community-based academic programs as “stepping stones” to a UArizona education, as well as enhance the college’s development of a culture that nurtures and sustains American Indian/Alaska Native students.

"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.

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.”