Looking at Health Through a Different Lens

A conversation with PhD student, Nicole Thomas, and faculty advisor, Prof. Lisa Bratzke

By Alexander André

Nicole Thomas
Nicole Thomas, PhD student, RN

As high school was coming to a close, Nicole Thomas, PhDx’23, RN, project assistant at the UW–Madison School of Nursing, wasn’t sure what path was in her future. She was working as a personal care giver in community-based residential homes. While much of that experience felt right, the way forward wasn’t clear. “From early in childhood, I recognized I was a bit of a caretaker. That was just an inherent part of my nature,” explains Thomas. “I was that type of person that just wanted to extend myself to help people along the way.”

Lisa Bratzke
Lisa Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA, Assoc. Professor, School of Nursing

Thomas ended up finding a pamphlet about practical nursing, and things just clicked. “I started my journey as a nurse, and I absolutely loved it; from that point I realized, ‘Yep, this is what I’m going to do!’” Her journey has brought her through many different perspectives of nursing, from bedside to research. Under the advisement of Lisa Bratzke ’88, MS’92, PhD, RN, ANP-BC, FAHA, Thomas is using her PhD program to develop research in the burgeoning field of epigenetics and the intergenerational transmission of trauma.

What led you to pursue your PhD?

NICOLE THOMAS: I know a lot of people approach their nursing careers and education differently, but starting out as a personal care worker, and then a CNA, then a practical nurse, then an associate degree nurse, and then a BSN has allowed me to see the effects of nursing care through different lenses. It’s been a good evolution to help understand how the different social dynamics that are occurring in the world can lead to the embodiment and manifestation of health.

The path to my PhD really started in my last position, which was research oriented. The principal investigator (PI) was a maternal fetal medicine doctor, and her study was looking at the health of women with postpartum hypertension. Based on her hypotheses and research design, she implemented a postpartum program for remote patient monitoring of women at risk for severe high blood pressure. My job was to monitor the patients daily, and then implement interventions based on our nurse-driven protocol.

Though we didn’t have a lot of women of diverse ethnic backgrounds in the program, from an anecdotal perspective, it often appeared that participants who identified as women of color to have higher and more aggressive blood pressures. Often what I was implementing also didn’t seem to have the same effect on these participants as it did for the white participants with the same diagnoses, with or without similar socioeconomic status. This kept happening, and I started asking questions about why this was happening.

Although some may find this controversial, I view race as a social construct, not a biological factor, so why am I seeing increased incidence of women of color exhibiting these symptoms seemingly more severe, especially when from similar socioeconomic backgrounds? I started doing my independent research after speaking with my PI, who introduced me to the weathering hypothesis. The weathering hypothesis was formulated by Arline Geronimus, Sc.D., and it discusses how the effects of systemic and interpersonal racism can be embodied within people, and essentially manifest symptoms. That was really my “a-ha” moment.

How are you applying your experience to your research?

THOMAS: Essentially, I have taken the experiences that I’ve gained at the bedside and my prior research position, and decided to look into how they relate to Native American women in the United States. I’m really interested in learning how current societal constructs can perpetuate the effects of historical trauma, the subsequent effects on health, and the pathways in which traumas can transmit to future generations.

There are theories saying that genetic changes and epigenetic changes may occur from historical and other types of trauma, which can be passed down from potentially heritable and non-heritable pathways. My interest focuses more so on the potential epigenetic changes resulting in non-inheritable pathways of trauma being reproduced and ways to mitigate these risks by assessing the upstream determinants of policies in and outside the health sector contributing to this cycle. I’m interested in looking at why and how disparate outcomes are occurring from a different lens, an indigenous lens. I am approaching this research from specifically an indigenous lens, with decolonized approaches, to match the resiliency, life experiences, and the epistemology of a culture that may not be in alignment with westernized medicine. It’s a really interesting topic for me that I’m hoping to become more of an expert on.

LISA BRATZKE: The other thing [Nicole] is looking at is health equities, and what she’s finding is that some of what typical western medicine considers good health outcomes may not encompass outcomes important to many Native American people. We don’t even have the tools necessarily to measure what these good health outcomes could look like because no one’s really taken the time to learn what good health outcomes are within that native population. That sets a whole other sort of wheel in motion around health care, and what we need to be advocating for and thinking about when we’re taking care of our patients.

“Being an advocate is always something we’re doing for our individual patients, but I also think that nurses have the ability to affect change within their communities, at the national and even global level by advocating for equitable health practices to be implemented within policies.”
— Nicole Thomas

How important is advocacy to nursing, and how are you incorporating it as you work on your PhD?

THOMAS: I think that nurses in general have the term “advocate” embedded within them! That is what we do in bedside nursing. Being an advocate is always something we’re doing for our individual patients, but I also think that nurses have the ability to affect change within their communities, at the national and even global level by advocating for equitable health practices to be implemented within policies.

For me, I feel that any type of policy is a health policy, even if originating outside the health sector. All policies have the risk to overflow into other areas of life, which could then affect people’s health. I don’t have a wealth of policy knowledge, but what I’ve observed over the years is that elected officials are typically going to represent the concerns from their constituents who represent the majority. Yet, as nurses, we know and see that much of the health policy formation that is most needed is usually for our underrepresented populations.

If patients are underrepresented in health care settings, it’s my assumption that they are likely underrepresented constituents as well. My logic guides me to believe that this is a barrier for policy formation among the underrepresented. As nurses, and as one of the largest workforces, I feel it’s important for us to act as unified representatives in our community to represent those groups who don’t have the support in numbers behind them.

I think some areas that have been under-investigated in native populations may be related to the upstream determinants of health. By identifying what upstream barriers are occurring from a socio-political standpoint, we can advocate, support, and implement more effective policies that enhance health and look at their potential outcomes holistically.

BRATZKE: Advocacy is really a huge part of why Nicole’s research is so important, because she’s not only teaching patients how to advocate for themselves, but also encouraging communities to form solidarity and advocate for their neighbors. There are different populations that are more vulnerable than others, and different populations that are less likely to advocate or be able to advocate for themselves.

Part of nursing research is to build the science, and when you build the science, you’re better able to advocate for newer or different treatments. Things like precision medicine; as we’ve been able to build the science, we’re better able to advocate for our patients in terms of what they actually do or do not need.

THOMAS: We have the knowledge of the health of populations because we are working with patients at the bedside and seeing how policies may be affecting their lives directly and indirectly. We have that insight, that powerful insight, that allows us to speak to and advocate for people who may not be able to make those connections, and we have the ability to articulate to representatives on the hill.

I think that nursing is an important discipline that is able to transform health in the United States. I’m proud to be a part of that; I’m proud to be at this university.