The Spring 2022 issue of ForwardNursing magazine.File: forwardnursing-spring-2022.pdf
Innovative research is essential to our educational mission to develop leaders for the profession and society. Making discoveries, enhancing systems, and improving health through research, education, and practice requires creative problem solving in every aspect of what we do. We are fortunate that Signe Skott Cooper Hall was designed — and continues to evolve —to inspire teaching, learning, and collaboration. It is an ideal learning lab for nurse leaders; a place to develop new ways to improve health through team science.
Innovation drives the methods and foci of research and scholarly work being conducted in the School, in health systems, and in the communities we serve. Our aims and approaches challenge the status quo. By doing so, we are able to reach understudied and underserved populations. The School’s impact is then furthered through collaboration to disseminate knowledge and translate it into evidence-based practice. This leads to partnerships with others who share our aspiration to improve health outcomes for all.
The School’s ability to achieve such meaningful impact through academic nursing today is made possible by its history and legacy of leadership. Since 1924, nurse educators and scientists in the School of Nursing have prioritized excellence in teaching, learning, research, and mentorship. They—and, in turn, our alumni—have contributed their expertise and vision to leverage developing knowledge and new and changing technology in service to the profession. Signe Skott Cooper spoke to this when she described pushing boundaries as a school. She said, “We were on the cutting edge of changes in nursing and were able to explore many new approaches to helping nurses learn and improve their practice.”
Indeed, the School has responded to changing health needs, complex care systems, and persistent societal challenges for nearly 100 years. Yet, it is possible that the greatest threat we have faced has been the Covid-19 pandemic of the past two years. It is a credit to our faculty, staff, students, and partners in research and clinical care settings that we were able to achieve continuity in our academic and research enterprise.
The difficulties presented by the pandemic could have set us back in mastery, progression, or discovery. Instead, potential disruption was met with determination to create new ways to teach, learn, collaborate, investigate, and remain on course. The School of Nursing community was uncompromising in our standards and commitments. Our response to the pandemic is yet another illustration of adaptability that has characterized the School’s past. This will also be our path to maximizing future impact.
This issue of Forward Nursing features research in the School of Nursing. As you read, you will recognize how research programs and scientific approaches are driven by shifts in society and health care alike. Our faculty, staff, and students apply an equity lens to better understand unmet health needs. Then, they formulate innovative research aims and methods to develop knowledge in the context of changing populations and circumstances. I know you will be inspired at how the School is advancing nursing science to expand our opportunities to improve, protect, and promote health for all.
As we continue our trajectory, we will pursue strategic growth and collaborative partnerships in areas that are critical to our mission. We will look to you for support as we gather momentum and resources to educate and prepare the next generation of innovative nurse scientists, clinicians, and educators. It is an honor to share this work with you.
Linda D. Scott
For two School of Nursing faculty, pediatric palliative care and symptom science drive their innovative research
By Grace Houdek
The Effects of Discordance
When Assistant Professor Kitty Montgomery, PhD, RN, PCNS-BC, CPHON, noticed misalignment in the way young children with cancer report their symptoms compared to the way their caregiver does, she scratched her head and wondered why this occurs.
“Children with cancer and their parents don’t always agree on the symptoms the child is experiencing,” says Montgomery. “More often, parents are saying symptoms are there when the child says they are not, or that the symptoms are there, and they are happening at a higher degree.”
According to Montgomery, this discordance can occur for various reasons, including if the caregiver themself has a history with handling mental or physical illness, or is also living with a chronic health condition. Parents may feel more “in tune with what’s going on, both from a psychological and physical perspective, and therefore feel like they are recognizing more symptoms than their child is reporting,” said Montgomery.
The results of this could mean improper courses of treatment. Overestimating symptoms raises the concern of putting the child on incorrect or unnecessary medication, and if symptoms are underestimated, then the child may not receive the proper care they need. While research on the effects of discordance is ongoing, Montgomery notes, “Evidence suggests parents can overestimate physical symptoms, but underestimate psychological symptoms, or those that don’t have an obvious visual cue.”
This discordance is why it’s important to not rely solely on the parent’s symptom report. It’s because of this that Montgomery’s research focuses on children, specifically children with advanced cancer, using their symptom reports and gathering data utilizing technology to generate better patient-reported outcomes.
It comes with many challenges. While children can inform their health care team about how they are feeling, symptom experiences look and sound different from one child to the next. “We still don’t have answers to the question that guides our work; why do children who have the same disease and same treatment have vastly different symptom experiences,” said Montgomery. “One of the gaps we have clinically is we don’t have a systematic way that we assess symptoms. We have all these nice tools, but they are not integrated into the clinical setting.”
Because of this, Montgomery has found that it is crucial to use the child’s input whenever possible while also ensuring assessments are done through child-friendly language that is specific to adolescent development.
The hope, she says, is to advance the science further by investigating patterns of symptom burden in children with advanced cancer to enhance the understanding of factors that place children at risk for high symptom burden. “If we can identify those factors, we can implement personalized symptom management strategies to mitigate suffering and improve quality of life,” said Montgomery.
Montgomery acknowledges that trying to completely get rid of symptoms is a hard ask, but points out that management of symptoms can be better, saying, “We’re not going to come out and say we can achieve zero symptoms, suffering, or distress — but we should be able to reduce it.”
The “Long Arm” of Pediatric Illness
Addressing symptom management at a young age with the goal of bettering palliative care is important when it comes to management of a serious or chronic illness. However, Assistant Professor Anne Ersig, PhD, RN, also notes that it has the potential to address long-term health as it helps to alleviate stressful situations that can have lasting impacts on one’s life course.
Ersig focuses her research on stress and anxiety associated with chronic illnesses, exploring how adolescents with childhood chronic health conditions, as well as their families, respond to illness-related stressors.
Through her research, she has found that it is common for children to have high levels of stress due to their illness. “Experiencing stress from a chronic condition is normal, [the illness] is a stressful situation,” said Ersig. “People are unique, but it’s likely that anyone who experiences it is going to undergo some degree of stress from it. The goal is to make sure that stress is well managed and is as low as it can possibly be for each person.”
“One of the gaps we have clinically is we don’t have a systematic way that we assess symptoms. We have all these nice tools, but they are not integrated into the clinical setting.” — Kitty Montgomery
While there is little research to know the life-long effects of childhood chronic illnesses on mental health at the moment, Ersig has found that the extremity and presence of stress in one’s adolescent years has a “long arm” into adulthood and is higher for those with childhood-onset chronic illnesses. “The immediate effects of early life stress and adversity on children’s lives are profound,” said Ersig. “Evidence also connects early life adversity with adult health and well-being. This means that we need to improve identification of those at increased risk earlier in their lives, and then develop and apply appropriate interventions to improve health and well-being across the entire life course.”
Ersig notes that most kids with chronic health illnesses have normal life expectancies – meaning they will be living with, and managing, symptoms that come naturally for a long time.
“We’re not likely to ever be able to cure them all. We may be able to mitigate some of the effects of [their illnesses], but there are always going to be chronic health conditions that need to be managed, and there’s always going to be stress generated from living with those health conditions,” said Ersig.
Finding The Right Tools for the Job
While illness-related stress will most likely never go away, nurse researchers like Montgomery and Ersig are hoping to make life a little easier for pediatric patients by providing them with proper tools and care to address their needs — both short and long term.
After asking the “why,” they are now both addressing the “how.” Instead of allowing health care workers to maintain reactionary methods, they are finding ways to be more proactive in assessing and treating symptoms earlier and more accurately.
Knowing that there is still work to be done and questions to be answered, research by Montgomery and Ersig is ongoing. However, both have earned recent recognition for their work and each have been awarded several grants to support their respective areas of research.
For both Montgomery and Ersig, the work they are doing to improve palliative care and symptom science for pediatric patients highlights just how important it is for nurses to continue to ask the important questions as they continue to search for ways to ease not just the short-term, but long-term symptom burden for pediatric patients.
Meet Nancy Fraser Michalski ’82, the new chair of the Board of Visitors (BOV), and vice president of med legal services for Elevate Services. She has over 35 years of experience, including as an RN, nurse entrepreneur, and in medical billing. A nationally recognized expert, Fraser Michalski has extensive experience testifying in both state and federal courts about medical services and the pricing of medical care.
Q: Tell us a little about your career and what has led you to your current role.
Michalski: A few years after receiving my BSN from UW–Madison, I was given an amazing opportunity to help build and open the second surgery center west of the Mississippi, which launched in 1987. I worked in the operating room as director of surgery and the medical billing department. I ran that business for 17 years until the facility was sold in 2001. I then started my own business working with lawyers on bodily injury cases providing medical records analysis, medical bill audits, and life care plans. I grew this business over 10 years working with law firms, insurance companies, and the corporate law department to improve case outcomes. In 2012, Elevate Services, a global start-up law company, acquired my business. I now run the Med Legal team in Elevate, continuing to delight customers and grow the business I started 20 years ago.
Q: What are your goals for the Board of Visitors over the next few years?
Michalski: As the leader of the BOV, my primary goal is to support Dean Scott in achieving her vision for the school as we head into our centennial and commemorate the impact of Badger nurses. Our focus in the coming years will be to further align board composition with the future of nursing, continue to enhance alumni engagement, prepare for our centennial celebration, and support the School’s fundraising initiatives. It will be an exciting time in our history as we prepare for a spectacular 2024 that launches Badger nurse leaders into the next 100 years!
Q: If you had 60 seconds to pitch the board to a prospective member, what would you say to convince them to consider joining the BOV?
Michalski: If you have a passion for impacting health through the nursing profession or are compelled by the opportunity to improve lives and communities through equitable health care, then you would be honored and gratified by contributing your time, expertise, and resources to support the School in this way. As a Badger nurse, I am proud that my alma mater demonstrates leadership to this extent. However, the reward comes from feeling connected to the School’s ability to prepare Badger nurses who change lives, impact health, and build equity.
By Esther Seidlitz
Wisconsin Foundation and Alumni Association
In 2014, longtime benefactors of the University of Wisconsin–Madison John and Tashia Morgridge announced a giving program that has changed the university’s trajectory. Before this $100 million Morgridge Match, it was more difficult to entice the best and the brightest to the UW. It was hard to compete with the warmer weather, higher pay, and greater opportunities for endowed positions that other schools could offer to highly qualified educators and researchers.
That’s not to say the Morgridge Match provided the direct funding necessary to hire brilliant new faculty members. Rather, it encouraged other donors to participate in the support and retention of the excellent faculty already at the university through endowed chairs and named professorships. As Chancellor Blank said at the time, “These new chairs will provide appreciation, resources, and professional status to highly productive UW faculty; they will help retain these researchers at UW; and they will give us additional tools to recruit new rising stars from elsewhere to Madison.”
In addition to a more prestigious title, recipients of faculty endowments receive additional funding from the investment returns to supplement their income, pursue new avenues of research, buy better equipment, and hire research assistants. These benefits ultimately build up and contribute to a greater culture for both faculty and students, making the UW a more competitive school in terms of recruiting and retaining talent.
With the Morgridge’s matching program, other generous donors were able to double their capacity to endow professors and cement their legacies at the UW. A $500,000 donation or commitment became $1 million to endow a professor and a $1 million commitment became $2 million to name a chair.
Richard Sinaiko is one such donor who maximized his ability to give back to a beloved institution on his own terms and according to his values. The Richard E. Sinaiko Professorship in Health Care Leadership now funds the scholarship and efforts of Barbara Pinekenstein ’73, DNP, RN-BC, FAAN, who is working to educate and empower the next generation of nursing leaders. As a Madison native, the son of a nurse who graduated from the Wisconsin School of Nursing, and a prominent health care leader, Sinaiko’s endowment is a gift that will keep on giving back to the things that are important to him.
While Pinekenstein is grateful for the additional support she has to pursue her own passions, she is more grateful for what her endowment has meant to the School of Nursing and to Sinaiko. As she explains, these endowments “are about supporting excellence and helping to support the vision of the school, and linking the hopes and dreams of the donor and the vision and mission of the school.”
Such gifts will continue to support the university beyond any one recipient’s tenure. Renewed commitments from donors like the Morgridges and constant support and generosity from the UW community has helped double the number of endowed faculty at the university in the last seven years. Since 2014, the School of Nursing has gained a total of six named chairs and professors, three of which were established within the last year.
In the last year, Lisa Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA, Barb King MS’87, PhD’10, RN, APRN-BC, FAAN, and Linda Oakley, PhD, RN, received new appointments as endowed professors and chairpersons. These endowments, established by generous donors, reward these educators for their dedication to the School of Nursing, honor their achievements, and improve their resources. These rewards will keep on giving back as endowed faculty members are empowered to advance the School of Nursing and its students through innovative teaching and research.
Meet the Newest Endowed Faculty Members at the School of Nursing
Lisa C. Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA
Sekelsky Professor for Education Innovation, Associate Dean for Academic Affairs
- PhD, University of Nebraska Medical Center; Nursing
- MS, University of Wisconsin–Madison; Nursing/CNS Education
- BS, University of Wisconsin–Madison; Nursing
After more than 20 years of clinical practice, Lisa Bratzke brought her expertise to the UW as a faculty member in 2013. In addition to her newly-named professorship, awarded in January of 2022, she served as SON’s Undergraduate Program Director and Honors Program Coordinator and recently accepted the Associate Dean position for Academic Affairs. Bratzke focuses her research on brain health and cognitive aging with the goal of slowing cognitive decline and improving self-management of chronic diseases such as Alzheimer’s.
Barb King, MS’87, PhD’10, RN, APRN-BC, FAAN
Charlotte Jane and Ralph A. Rodefer Chair
- PhD, University of Wisconsin–Madison; Nursing
- MS, University of Wisconsin–Madison; Nursing
- BA, College of St. Scholastica; Nursing
Barb King has been teaching at the UW for over a decade. She seeks to improve outcomes for hospitalized older adults by investigating patient experiences, fall prevention methods, and ambulation recovery processes. This expertise has made her a very valuable director of the Center for Aging Research & Education. King’s chair position, awarded in July 2021, recognizes her excellent research and allows her to pursue it further.
Linda D. Oakley, PhD, RN
Louis J. and Phyllis Clark Jacobs Professor in Mental Health
- PhD, Univerisity of Washington; Nursing Science
- Post-Doc, University of California, San Francisco; RWJ Clinical Nurse Scholar
- MS, Boston University; Psychiatric Nursing
- BS, California State University, Chico; Nursing
Linda D. Oakley has been expanding and sharing her expertise at the UW for 30 years while continually serving Dane County as a psychiatric nurse practitioner. Her research focuses on the social determinants of public health outcomes in Black communities, including stigma, trauma, and cultural resilience. Oakley’s new position, awarded in July of 2021, will give her more resources to study mental health issues and strengthen communities with self-management strategies.
Contact a member of our development team to learn more about endowments
Director of Development
Associate Director of Development
By Grace Houdek
As a senior in high school, Courtney Maurer ’12, DNP’21 thought about a range of careers, including journalism, psychology, and social work. But after seeing the way her grandmother was taken care of in hospice, she discovered her calling to work directly with patients as a nurse.
After graduating with her bachelor’s degree in nursing, she worked in an adult general care unit at University Hospital for two and a half years. She then transferred to the cardiac intensive care unit where she still works part-time.
While working as a bedside nurse, Maurer also attended school part-time to earn her doctor of nursing practice in adult-gerontology acute care. As part of her final capstone to receive her doctorate, she completed an evidence-based quality improvement project.
“I was in a place where I had to really think about what this project was going to be that was going to consume my life over the next year,” said Maurer. “I wanted it to leave a mark, and I wanted to make a difference. But also, it has to be something I’m passionate about.”
Inspired by the social activism of the Black Lives Matter movement in 2020, Maurer asked herself, “What am I not good at when it comes to dark skin and patients with dark skin tones?”
Through her reflection, Maurer realized she did not know enough about assessing and documenting pressure injuries on people with dark skin. While the skills are taught in nursing programs, nurses practicing in predominantly white communities often experience a lack of exposure to patients of various races and ethnicities in practice. This leads to fewer opportunities for those nurses to practice and maintain their skills.
“If you’re not exposed and you don’t know, it’s okay. You just have to ask and find those resources and seek them out,” said Maurer.
During her project, Maurer found extensive literature on dermatology for dark skin, but very little about pressure injuries.
Pressure injuries in light skin tones are revealed earlier as it is easier for nurses to visually see changes in the skin. However, assessing dark skin for pressure injuries relies on touch. “Your eyes can deceive you. Folks with dark skin who have pressure injuries, you really want to feel the skin,” said Maurer.
“The nurses are the first ones to notice skin changes. When you have someone with dark skin and you’re not necessarily taught how to assess that differently, you miss things,” continued Maurer. She added that missing pressure wounds can lead to the breakdown of the skin, which can go down through the muscle layers to the actual bone and cause deadly infections.
She began her research by surveying the nursing ICU staff at University Hospital to understand what their past experiences, knowledge, and perceptions were with dark skin. Not surprisingly, many nurses lacked confidence and understanding of what needed to be done differently when assessing darker skin tones.
Through this survey, she discovered a need to update documentation charts so nurses can better report what they see. “Our charting was not optimal; there were not options to document someone’s skin as black or purple or maroon or some of these colors that were non-white,” she said. “You can assess someone, and you can find something, but unless you have the capability to document it [via] electronic record charting, you’re going to miss it.”
Maurer also created a five-minute instructional video where she modeled a skin assessment on a patient with dark skin and shared it through UW Health and the School of Nursing. Additionally, she collected follow-up surveys, shared visual examples of injuries, and developed a list of resources recommended by national guidelines.
The project concluded in 2021, but the work is not done. Maurer has since passed the assignment down to another nurse and current UW DNP student who will continue to spread awareness and educate peers.
Over the last decade, Maurer learned that trying something new is not easy, but the rewards for persevering are invaluable.
“Push yourself into a topic or field or something you’re uncomfortable with but super curious about because that’s what’s going to keep your interest,” said Maurer.
School of Nursing staff and alumni are demonstrating why diversity within research is critical to health outcomes.
By Maggie Ginsberg
Native Hmong speakers. LGBTQ+ and nonbinary populations. Indigenous, Black, and Latinx communities. Victims of trauma and gender-based violence. All of these groups, while diverse even within themselves, have one key thing in common: They are vastly underrepresented in scientific research and therefore underserved in health care.
“I really do observe that there’s a lower quality of care for non-English speaking individuals,” says Maichou Lor ’11, MS’12, Cert’14, PhD’17, RN, a School of Nursing assistant professor and researcher focused on data collection to improve care for those with communication challenges.
She’s also a Hmong refugee who came to the United States in 1994 at the age of six. “The general absence of health data on the Hmong population and other subgroup populations really raised a lot of questions for me,” says Lor. “Why are they not included in surveys? What are the health disparities they encounter, and how can health disparities be addressed in the absence of data?”
Those are big questions that extend beyond the Hmong or other non-English-speaking populations — and Lor isn’t the only School of Nursing faculty, staff, or alumni for whom the mandate to close those gaps feels personal and pressing. But even for those who aren’t part of a non-majority population, diversity in research is foundational in creating objective measures that give nurses data and ultimately deliver better outcomes for every patient.
“Nurses are the number one most trusted profession, so we need to be trustworthy for everybody, not just for the people who look and talk and live like us,” says Madelyne Greene, PhD, RN, whose research examines the systemic mechanisms that cause and perpetuate disparities in sexual and reproductive health. “The reason that we need diversity in nursing research is because there’s no possible way that a homogenous group of people is going to be able to ask the right set of questions that will encompass what each and every person experiences in care, and academic nursing right now is homogenous; it is overwhelmingly comprised of white women.”
Luckily and notably, there is a wealth of innovative research currently underway by UW–Madison School of Nursing leaders to address these health inequities, and more.
Bridging the Linguistic and Cultural Gap
Lor earned her bachelor’s, master’s, and doctorate in nursing from UW–Madison, and grew up deeply embedded in Wisconsin’s Hmong community. Even before she had the data, she knew anecdotally that something wasn’t right about the health care she and her community received — or, more to the point, didn’t.
“There’s more and more cardiovascular disease in the community, and people are really scared because they don’t know how to manage it,” Lor says. “And a lot of these things are manageable and preventable if their blood pressure was addressed or if their diabetes was addressed. But people don’t quite understand the concept of chronic conditions, and one of the biggest factors is addressing the culture and language component.”
While the Hmong language has unique challenges—it is primarily oral, and even many of its native speakers can’t read or write it—other refugee and immigrant communities face similar barriers. Even communication through metaphors or verbal expressions, such as tonality or elongation of a word to differentiate severity of pain, doesn’t always translate between cultures.
“I did a pain characterization study and we learned that, for example, Hmong patients would describe pain in metaphors such as, ‘It hurts like chicken pecking’ versus saying ‘It’s throbbing,’” says Lor.
Lor was awarded a K23 grant to help the Hmong population communicate their pain symptoms in culturally and linguistically appropriate ways, working with a previous physician and a Hmong resident at the UW Health Northeast Family Medicine Clinic to map Hmong metaphors into the western medical terminology and co-creating images to supplement intake assessment forms. This further built on her dissertation, during which Lor received a fellowship through the National Institutes of Health (NIH) to develop and test a novel data collection method for the Hmong population to increase their participation in surveys. That method utilized an audio computer-assisted self-interview system that ultimately took those oral translations and color coded them into categories. Then, they were presented to the subject simultaneously with written English text for a family member to help assist with the survey.
More recently, Lor is collaborating with a physician, an audiologist, and a linguist to develop the “Word Recognition Test in the Hmong Language” — one that doesn’t yet exist in the U.S. — leveraging oral surveys, folklore and children’s books, as well as audiometric testing traditionally used to diagnose hearing loss. She has also received a Baldwin Wisconsin Idea Grant from the university to enlist the Hmong community’s help in creating a dictionary and glossary of Hmong health concepts for use by medical interpreters.
To help address the history of distrust between underrepresented populations and public health systems that are contributing to these groups not being reached, Lor is collaborating with the director of the Wisconsin Longitudinal Survey. Together, they aim to develop a community-based advisory group to build infrastructure for engaging the Hmong community in research and public engagement and education efforts. That engagement and bridging the overall communication gap is so critical to health outcomes.
“All of the work I’ve been doing is really trying to address the culture and language component so that we can bridge any gap related to any kind of health condition,” Lor says.
Using Research to Support Indigenous Survivors of Sexual Assault
According to a nationally representative sample from the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, of 2,473 Indigenous women in rural, reservation-based, and urban areas, 84.3% reported that they had experienced violence during their lifetime. As a PhD prepared nurse researcher, an enrolled member of the Bad River Band — one of six Ojibwe bands in Wisconsin that are federally recognized tribes — and a survivor of intimate partner violence herself, Jeneile Luebke ’02, MS’09, RN, PhD, wanted to better understand the prevalance of this experience.. More to the point, she wanted to apply research to make it stop.
“One of the biggest pieces I wanted to understand was, ‘What are the barriers to help-seeking?’ Because I knew, even as a highly educated woman, I kept that secret,” Luebke says. “I just didn’t trust anyone enough to talk about what I had experienced.”
Luebke, who will begin a faculty position in the School this fall as an assistant professor, first came to UW–Madison through the RN to BSN program. She then earned her master’s degree from the School of Nursing and went on to teach clinical courses at Edgewood College for 11 years. In addition, she spent five years as the maternal health nurse for a local Native American tribe, visiting mothers and babies in their homes.
“That was really my first introduction to understanding the health impacts of intimate partner violence and sexual assault and intergenerational trauma,” she says. “What most people didn’t know then is that I knew all too well what intimate partner violence was, but what I didn’t realize is how many other Indigenous women were experiencing it as well.”
Luebke found completing her PhD program to be a healing experience for her. For her dissertation, beginning in February 2020, she conducted lengthy interviews with 34 members of Indigenous tribes in Wisconsin; some were multiracial, all were between the ages of 18 and 55, and 2/3 had never sought formal help after experiences of violence. “It was just kind of exploratory, because there were no published academic studies about this in Wisconsin,” Luebke says. Then the pandemic hit, aggravating all of the factors that exacerbate instances of domestic violence, something Luebke was able to witness and track in real time, unfortunately.
“When our curriculum is very medical-model based and not holistic, and we’re not learning about the neurobiology of trauma and how that impacts our health, it’s really easy to pass someone off as non-compliant or difficult.”
– Jeneile Luebke
In May 2020, her research team received a $2 million Department of Justice (DOJ) service grant, named Tracking our Truth, to expand options for culturally relevant, advocacy-driven, and safe medical forensic care to American Indian women in Wisconsin after experiences of sexual violence. Luebke defended her dissertation that August and got right to work in her post-doctoral fellowship at UW–Madison. Tracking our Truth specifically allows for the hiring of Indigenous advocates and Sexual Assault Nurse Examiners (SANE), and also offers a free 40-hour culturally specific sexual assault advocacy training program by Red Wind, an Indigenous-led nonprofit organization created in response to the increasing needs of Tribal and Native specific programs to develop culturally specific responses to domestic violence, sexual assault, and stalking. The grant also provides a a free 40-hour SANE training, plus a two day skills lab course through the International Association of Forensic Nurses (IAFN) to help more nurses become SANE-certified, and partners with agencies across the state to help them set up their own SANE programs. The trainings are held both in Milwaukee and the northern part of the state.
This spring, she’s a co-investigator and key part of a new multi-site NIH R01 grant for a mixed-method study interviewing individuals as well as conducting focus groups and surveys to look at the barriers to care after experiences of violence during COVID-19 for Black and Indigenous women. Using research to understand how intersecting identities affect overall health is critical to good nursing care — and isn’t always obvious.
“When our curriculum is very medical-model based and not holistic, and we’re not learning about the neurobiology of trauma and how that impacts our health, it’s really easy to pass someone off as non-compliant or difficult,” she says. “Nurses really need to understand that sometimes people come in and they’ve had a traumatic experience and don’t always present like a typical person (who hasn’t experienced trauma). And if people have bad experiences during their interactions with nurses and other providers, especially Natives or other people of color, they’re likely not to come back.”
Using Indigenous Practices to Prevent Chronic Disease
Angela Fernandez, PhD, MPH, LCSW, joined the School of Nursing as an assistant professor through the campus Native American Environment, Health and Community faculty cluster. Trained in clinical social work and public health with experience working across nations and health care settings, she brings a unique perspective. But it’s her identity as an Indigenous person that drives her research, which examines the role of cultural practices that involve a connection with Nature — like gathering wild rice or burning sage in prayer — in the prevention of chronic disease.
“In my community, the woods is a place of healing,” says Fernandez, who grew up on the Menominee Reservation in northern Wisconsin. “You go into the woods to grieve, to participate in ceremonies — things that are important for healing emotionally and healing physically.” As a clinician, she also saw firsthand the multiple health benefits of connection with nature through community gardening among Milwaukee’s immigrant populations.
For Fernandez, research can illuminate Indigenous health interventions — which are culturally acceptable and sustainable. She has a grant to develop a psychometric measure based on interviews from American Indian participants across 10 tribes and three geographic regions, part of the American Indian Chronic Disease Risk and Sleep Health (AI CHERISH) study. The largest epidemiologic study of sleep health ever conducted with an American Indian sample to date, AI CHERISH studies how common sleep deficiencies are among this population, and whether they are associated with chronic disease, such as diabetes and cardiovascular disease. Fernandez’ grant takes it a step further; she wants to know how participants’ involvement with cultural practices that involve a connection with Nature may play a role in prevention. Does hunting, fishing, gathering, burning sage, or participating in other cultural practices connected with Nature make a difference in their sleep health or chronic disease outcomes, and does this vary by whether they live in urban or rural places? Fernandez’ psychometric measure is made up of 12 questions that are currently under review by tribal review boards. Upon approval, it will be added to the AI CHERISH survey, and will provide data which she can analyze to develop the measure and answer these questions. But the implications are even bigger.
“I have this opportunity as a researcher to tell the story of who we are and what’s important to us, and what makes us healthy.” — Angela Fernandez
“I have this opportunity as a researcher to tell the story of who we are and what’s important to us, and what makes us healthy,” says Fernandez, who has worked on similar NIH-funded studies. One such study, “Yappalli – The Road to Choctaw Health”, is a culturally-focused, strengths-based outdoor experiential obesity and substance use risk prevention and health leadership program that involved walking the Trail of Tears with Choctaw women. She sees her current research as inextricable from healing colonial traumas through human interconnection within Nature—not just studying disease, but the ongoing health practices that have helped Indigenous people survive and thrive. “I am very passionate about telling the story of why it is that we have the health disparities we have. When I look at colonization and historical traumas, I’m equally passionate about telling stories of why we are so strong and so resilient.”
Innovating Reproductive Health
As a Hillman Fellowship recipient, Greene’s doctoral program was specifically focused on innovation in nursing research. “Typically, when people think of innovation they think about technology,” Greene says. “But there’s a lot of innovation and creative thinking that needs to happen in our health system and in the broader social structures that we now know so deeply impact health outcomes.”
Greene’s research is focused in two arenas. One is focused on LGBTQ+ health, specifically experiences with sexual and reproductive health care — the knowledge dearth, care gaps, exclusion, discrimination, biases, and assumptions. The other arena homes in on maternal health outcomes, especially for racial minorities. Wisconsin, for example, has one of the worst maternal mortality racial gaps in the country. Greene believes that’s due to largely preventable causes and highly variable access to maternity care, including where a person lives.
“I’m interested in thinking about how to get the highest quality, most up-to-date and relevant, personalized care to populations that are traditionally marginalized or structurally excluded from receiving that super high quality and tailored care,” she says, citing the example of trauma center levels and corresponding protocols. “If you live in a rural area and you go to a small hospital because you had a stroke or an accident, people in the ER know exactly what to do to try to stabilize you and get you to the next correct place. If you go to a hospital that doesn’t have the right resources, there’s a very clear system to transport you to the next level. But in maternal health and obstetrics, that system does not exist.”
“There’s a lot of innovation and creative thinking that needs to happen in our health system and in the broader social structures that we now know so deeply impact health outcomes.” — Madelyne Greene
Greene is building upon existing data sets created by fellow researchers at UW–Madison, including Dr. Deborah Ehrenthal and Dr. Lawrence Berger from the School of Medicine and Public Health, that include everything from birth records to Medicaid claims, to early childhood school records to incarceration records. Greene will additionally link to a data set of hospital-based information to track every birth hospital in the state – level of care provided, number of births each year, what resources they have, and more. “All of that is linked together so that we can trace back each delivery, the mother’s health history, and facility-based information about that birth, and try to start unpacking what happens at different levels of care and how better systems could be built.”
Part of Greene’s work is battling insidious cultural beliefs that continue today, further perpetuating these disparities that lead to poor health outcomes. For example, women’s complaints of pain tend to be taken less seriously than men’s, particularly Black women—she cites the article tennis pro Serena Williams wrote about the traumatic blood clot she suffered after the birth of her baby, and how her complaints of something feeling wrong were ignored—or the misnomer that queer women don’t need STI screenings or pap smears. “Their cancers are diagnosed at later stages, which we would have caught, so the assumptions are actually impacting care decisions and recommendations,” she says.
Leveraging the Importance of Social Networks for LGBTQ+ Populations
Elliot Tebbe, PhD, LP, is a psychologist who came on board as an assistant professor at the School of Nursing in the Fall of 2020. His research primarily centers on LGBTQ+ population mental health and disparities, particularly among the trans and gender diverse communities, or TGD. Lack of experience and training are still causing far too many negative interactions for patients, he says, even from well-meaning providers. As such, many patients rely more on crowdsourcing their social networks than on healthcare systems.
“I’m a queer and trans person myself and honestly, I don’t know that I trust my provider as much as I do first asking a lot of other trans folks, then judging that against what my provider says,” Tebbe says.
“Because I’ve been told all kinds of weird stuff over time from providers who don’t know what they’re talking about, or haven’t had that experience, or they’re operating on what they learned 15 years ago.”
Tebbe hopes his research can support TGD communities in receiving reliable qualitative data while also changing the system to serve patients better. One of his current projects is a competitive grant to support his study called “TGD Social Networks and Health,” which examines TGD communities in southern Wisconsin. He’s also conducting a qualitative study around sexual health among individuals in urban Midwest centers, as much of the existing research has been limited to the coasts.
In addition, he has received a two-year grant from the Office of the Vice Chancellor for Research and Graduate Education’s (OVCRGE) Understanding and Reducing Inequities Initiative with co-investigator Stephanie Budge, associate professor in the Department of Counseling Psychology in the UW–Madison School of Education, to support their pilot e-therapy trial addressing healing and stigma in transgender and nonbinary populations.
The grant allows them to recruit and train 10 Black, brown, Indigenous, trans, or nonbinary therapists to provide free counseling to patients who reflect these same identities. Sessions are recorded and data is collected along the way with a goal of addressing internalized stigma and the intersections of racism and transphobia.
“Don’t discount the power of that individual connection. Look for opportunities to advocate within the system. Educate other nurses. Educate other providers. Be fearless in trying to change the tenor of how trans folks are treated within clinic settings.” – Elliot Tebbe
All of this research, Tebbe says, is particularly relevant to nurses because they are typically a patient’s first interaction wherever they go. Although his work is focused on systems, he says he’s learned through his research that one positive interaction with a health care provider can make all the difference in the world for these patients.
“Don’t discount the power of that individual connection,” Tebbe says. “Look for opportunities to advocate within the system. Educate other nurses. Educate other providers. Be fearless in trying to change the tenor of how trans folks are treated within clinic settings.”
As the leading nursing research institution in Wisconsin, the School of Nursing requires an equally innovative environment that stimulates productivity, creativity, connection, focus, and well-being. Signe Skott Cooper Hall, home to Badger nursing since 2014, stands as one of the most innovative and advanced teaching and academic research facilities in nursing across the nation.
The five-story, 166,348-square-foot building is LEED (Leadership in Energy and Environmental Design) Silver-certified and meets the highest current standards for green engineering and sustainability, reflecting the School’s commitment to environmental health. The copious amount of natural light and green spaces also support physical and mental well-being for students, staff, faculty, and visitors.
Cooper Hall can also adapt to the ever-evolving needs of the nursing profession and health care with its high-tech classrooms and conference rooms, dozens of research project offices, and a large, flexibly designed third and fourth floor layout that accommodates office spaces and six signature research areas.
Words alone are not enough to convey everything there is to love about Cooper Hall. Take a peek inside to learn more about what makes it a key component to the innovative teaching and research happening at the School of Nursing.File: A-Place-for-Innovation-Spread.pdf
School of Nursing Faculty Recognized for Achievements and Contributions to Health Care
Three faculty members at the University of Wisconsin–Madison School of Nursing have been recognized for their ongoing contributions and professional achievements in health care with elections into the National Academies of Practice (NAP) as Distinguished Nursing Fellows.
In recognition of their significant and enduring contributions to professional health practice, Gina Bryan ’99, MSN’02, DNP’12, APRN, FNAP, FAAN, Traci Snedden, PhD, RN, CPNP, CNE, FNAP, and Susan Zahner, DrPH, RN, FNAP, FAAN, were welcomed into the NAP’s Academy of Nursing during a special induction ceremony on March 5 at the NAP Annual Convention held in San Diego.
Fellowship is an honor presented to those who have excelled in their profession and are devoted to furthering leadership in practice, scholarship, and policy in support of interprofessional care. Those elected join a distinguished team of professionals focused on advancing interprofessional health care by fostering collaboration and advocating for policies in the best interest of individuals and communities.
“The mission of the National Academies of Practice is to advance health and well-being through collaboration and coordination of various professions,” said Snedden. “As a pediatric clinician and leader with decades of experience caring for children and adolescents in critical care, emergency, sport, and school settings, I have a strong understanding of the impact of high quality, interprofessional collaborative health care on pediatric outcomes. I am honored to be named as a Distinguished Scholar [and] Fellow of the National Academies of Practice in Nursing.”
Bryan is a clinical professor and the director of the post-graduate psychiatry program at the School of Nursing. She teaches in the graduate nursing and pharmacy programs. She serves on research teams in the UW School of Pharmacy and the School of Nursing, and maintains an active clinical practice at Tellurian, Inc. in dual diagnosis treatment. Bryan serves on the National Academy of Science, Engineering and Medicine’s CARA task force. She also served on the Wisconsin Commission on Substance Abuse Treatment Delivery to research hub-and-spoke delivery models for opioid treatment as well as to identify key implementation considerations. Bryan’s scholarly interests focus on novel health care provider collaborations to improve access to medication assisted treatment for the treatment of substance use disorders, access to naloxone, and interprofessional education for professional health care students.
Snedden’s career represents broad interprofessional contributions in pediatric injury, more specifically concussion. As a pediatric clinician with decades of experience caring for children and adolescents in critical care, emergency, and sport and school settings, her contributions are evident in clinical practice, research, education and outreach, service, and school-based policy. She collaborates with athletic trainers, school nurses, physical therapists, and various MD specialties across the country to provide high-quality, coordinated interprofessional care post-concussion. The assistant professor also presents at national and international conferences, publishes in peer-reviewed journals, and had an op-ed in USA Today that highlighted equity issues in female concussion. She mentors students from several practice disciplines and serves on the executive board for the Brain Injury Association of Wisconsin. She has received multiple interprofessional awards for her commitment to pediatric injury.
Zahner is Associate Dean for Faculty Affairs and Vilas Distinguished Achievement Professor at the School of Nursing, with an affiliate appointment with the School of Medicine and Public Health. She has thirty years of professional experience in public health, nursing, and academic leadership. Zahner conducts research on local public health system performance and workforce education and practice. She also directs the Wisconsin Public Health Research Network where she leads a team developing an online residency program for new public health professionals. Zahner has taught community health nursing and program planning, evaluation, and quality improvement. She mentors PhD, Doctor of Nursing Practice (DNP), and master’s degree students in nursing and public health programs.
The mission of the NAP is to serve as distinguished professionals advancing interprofessional healthcare by fostering collaboration and advocating policies in the best interest of individuals and communities. Election into the prestigious NAP in Nursing is a lifelong appointment.
Founded in 1981, NAP is a non-profit organization built to advise governmental bodies on our healthcare system. Distinguished practitioners and scholars are elected by their peers from 15 different health professions to join the only interprofessional group of health care practitioners and scholars dedicated to supporting affordable, accessible, coordinated, and quality health care for all.
Fall 2021 issue of ForwardNursing MagazineFile: SoN-ForwardNursing-Fall-2021-web.pdf