More than Medicine

Linda D. Oakley meets with a patient.

By Cheyanne Carter

Photography by Todd Brown

At much younger ages, Black adults have disproportionately higher risks of developing high blood pressure (hypertension). Both predispositions are long-standing epigenetic and historical evidence of the stress and trauma marginalized Black communities can face. The American Heart Association (AHA) has prioritized cardiovascular health promotion to prevent the chronic health problems associated with hypertension.

Professor Linda Denise Oakley, PhD, RN, is taking the AHA’s heart health message to historically marginalized Black communities and nursing students. As the Louis J. and Phyllis Clark Jacobs Professor in Mental Health, Oakley is committed to using science to find health and well-being solutions to systemic hypertension present in Black communities. Her research, Nurses 4 Black Well-Being, seeks to fully implement the AHA priority by measuring and accurately defining key AHA psychological factors associated with cardiovascular health in marginalized communities.

Linda Denise (LD) Oakley
Linda Denise Oakley

Oakley is leading a team of nurse researchers and students from the School of Nursing and the School of Medicine and Public Health, and public health nurses with Public Health Madison and Dane County. With this impressive group of minds, her team advances the School of Nursing’s mission and the consensus report on the future of nursing in charting a path to achieve health equity.

“Real health care is not treatment,” Oakley expressed. “It’s not even prevention anymore — it’s promoting well-being and keeping people well.” She envisions the increased awareness of Nurses 4 Black Well-Being throughout the School of Nursing and the community can make equity a priority in cardiovascular health.

To understand the basis of this research, Oakley noted, one must recognize that while ordinary cardiovascular activity (i.e., taking the stairs) may help decrease hypertension for many people, Black people historically have not experienced these health benefits. Studies show that chronic stress reduces the effectiveness of otherwise helpful treatments. Oakley explained that everyday life for marginalized communities can expose people to constant biological and emotional pressure “under the skin” that becomes intergenerational.

“Marginalization is the combination of exploitation and exclusion… in combination with intergenerational epigenetics, it’s what keeps trauma in the community,” said Oakley.

The problem is vast, but Oakley and her research team are looking for solutions by surveying Black communities in Madison and using community engagement strategies to inform accurate models of strength, health promotion, and well-being. Oakley’s goal is to describe self-care methods for reducing this chronic stress pathway to hypertension and poor health.

One of the participants, Brian Bedford, expressed his gratitude for the effort to better the Black community in Madison through this research. Bedford is a social worker with the University of Wisconsin–Madison Odyssey Project, a program that takes a family approach to providing education and opportunities to low-income citizens. He also serves as an alderperson for the city of Madison, representing District 6, and is passionate about breaking down social and political barriers of generational poverty.

“Taking the survey, I was deeply appreciative of some of the questions, especially how it pertained to a historically marginalized people,” said Bedford.

Measuring Peace

First and foremost, Oakley has defined her target population as members of the Black communities in Madison. She indicates that a community is “what we leave in and what we leave out,” encompassing the total environment of individuals who have a shared identity or experience. This clear definition helped her develop a complex sampling method: word of mouth.

“You go to a zip code, and you start on Facebook and with flyers, but the best way to know that you have tapped into a whole community is by having its members pass the message along,” said Oakley. “Those are the people that are invested in this.”

Bedford is helping recruit participants by talking about the study with people from various outreach programs. In addition to being actively involved in his community, Bedford has experienced his own health complications in his battle with prostate cancer. He understands how stress impacts health outcomes and is excited to see Nurses 4 Black Well-Being confronting these problems head-on.

“It is raising awareness. I am a Black man who is also a prostate cancer survivor; [we] all know that we are at a disadvantage as a subgroup,” said Bedford. “This [research] is vitally important; our health needs, physically or mentally, are not being met.”

With the urgency of this issue in mind, Oakley’s study is underway. Acknowledging that stress is a major complication in all medical conditions, she is measuring how members of these communities define inner “peace.” There is a heavy emphasis on the importance of peace and its meaning to marginalized communities.

“[These] communities are told that blessings are given and received. However, peace is something that I own, it’s mine. Peace means I’m free if I say I’m free,” said Oakley. “Our data suggest that high levels of peace that reduce self-directed anger may increase self-acceptance and well-being in ways that might promote cardiovascular health.”

The bachelor of science in nursing (BSN) student assistants survey all study participants to gather information on their identity and key AHA factors. From their blood pressure levels and how physically active they are, to the stressors in their lives, and their description of peace for them — they are trying to identify accurate measures of positive well-being related to blood pressure. “If you can measure it, you can change it,” said Oakley. She is hopeful that a better understanding of health may be key to decreasing stress-related hypertension in marginalized Black communities.

Nursing is Leadership

Researchers with Linda Denise (LD) Oakley

Since the days of Florence Nightingale, nurses have been taught to take care of the whole person, even when medicine focused on physical ailments. This holistic approach to health care well-being perfectly positions nurses to lead research looking for quantifiable measures of peace as a potential AHA protective factor.

Oakley explained that this research is a step forward in mental health nursing, and the student leadership team is evolving health care for all communities.

“These students are working to teach people how to take care of themselves, that would be the greatest discovery of all,” said Oakley.

Leadership comes in many forms within Nurses 4 Black Well-Being, but Oakley highlights the doctor of nursing practice (DNP) student leadership team for taking the reins on the study. Their role is to guide undergraduate researchers in data collection and to manage multiple aspects of the study’s protocol to ensure accurate results. These leaders rise to every challenge the team meets along the way.

“It is not enough to just be experts in the science, you have to be able to envision the project beyond the obvious to see the possibilities,” said Oakley. “Every day, nurses must problem-solve with not only their clinical expertise but with their ability to understand their observations and manage logistics.”

Oakley wants to continue to inspire this kind of leadership throughout the School of Nursing. Nurses 4 Black Well-Being is purposeful in having Badger nurses reach out to and prioritize mental health care in marginalized communities.

“This is what UW nurses do; if [we] can find a way we’ll hit it and run. It’s why we’re here,” said Oakley.

Nurses 4 Black Well-Being School of Nursing Team:

  • Linda D. Oakley, Professor
  • Wan-Chin Kuo, Assistant Professor
  • Megan Miller, Assistant Professor
  • Jessica LeClair, PhD Candidate
  • Rick Voland, Associate Researcher
  • Anne McKittrick, Aaron Blomberg, Taylor Farnsworth, and Salma Salama, DNP Students
  • Dana O’Brien, Clinical Professor
  • Sherell Jackson, Clinical Assistant Professor
  • Undergraduate ABSN and TBSN Nursing Students