FALL 2015 VOLUME 16 NUMBER 1 Yale Nursing Matters

Toxic Stress: Its impact and how nursing is playing a key role in developing strategies of support page 6

Yale Nursing Matters

Interim Dean: Holly Powell Kennedy 3 Letter from YSN Interim Dean

Editor: Meghan Murphy 4 YSN Spotlight News Fall 2015 Yale Nursing Matters 6 Exposure to Toxic Stress in Childhood Cover and Pages 7 & 9 Illustrations Linked to Risky Behavior and Adult Disease by Vigg/Three in a Box

Contributing Writers: 10 Interprofessional Education at Yale: Breaking Down Serena Cherry Flaherty ’06 Historical Silos to Improve the Learning Experience Mary (Betsy) Groth and, Ultimately, Patient Care Ziba Kashef 11 Getting to Know YSN Dean Designate Ann Kurth ’90 Holly Powell Kennedy

Photography: James Anderson Yale Nurse iStock Robert Lisak 12 Class Notes Michael Marsland Harold Shapiro 13 Alumna Spotlight: Adele Pike ’84 Leo Sorel YSN Faculty, Staff, 17 YSNAA Board Update Students, and Alumnae/i 18 Alumna Spotlight: Lucy Garbus ’88 Design: Gregg Chase and Karin Krochmal 19 Student Q&A: Jessica Crowell ’17

Yale University School of Nursing Post Office Box 27399 20 In Praise of Preceptors West Haven, CT 06516-0972 203-785-2389 nursing.yale.edu

This issue of Yale Nursing Matters covers events that took place from spring 2015 through fall 2015.

C Printed on paper containing 30% post-consumer recovered fiber that has been independently certified to come from well managed and sustainable forests.

mat•ter n. Something that occupies space and can be Left: This summer, Lindsay Geoghegan ’16 worked in the Mukono perceived by one or more senses; a physical body, a physical District of Uganda. While there, she met Maria (pictured here substance, or the universe as a whole. A subject of concern, with Lindsay). Lindsay was performing a blood pressure screening feeling, or action. Something printed or otherwise set down on her in her village and prescribing blood pressure medication. in writing. v. To be of importance or value. Signify. “I actually was able to follow her medical management all 10 weeks I was there,” said Lindsay. “I loved getting to know her.” 2 YALE NURSING MATTERS VOLUME 16 NUMBER 1 MEANWHILE…

The origin of “interim” is mid-16th century from the word meanwhile, or provisional adjustment. When President Salovey asked if I would be willing to serve as the interim dean until our incoming dean Ann Kurth comes to YSN in January, of course I said yes. I will do my best to provide that provisional adjustment and am honored to serve as what I consider to be a “bridge” to a new era at YSN and to build a stronger community. I also look forward to working in partnership with Dr. Kurth as we forge this new future built on the past 10 years of Dean Grey’s leadership. Our talented and committed faculty, staff, and student body are working on some major initiatives upon which Dr. Kurth will build. We have undertaken a major redesign of our curriculum. This will improve currency, increase efficiency, reduce redundancy, and extend scarce clinical sites. The redesign will enable YSN to accept and graduate more students who move more quickly into the workforce and to enhance interprofessional education. We are also creating pathways for ease of transition to doctoral study and clinical residencies. To this end YSN recently received a grant to provide mini iPads for our prespecialty nursing students to use during their longitudinal clinical experience. In collaboration with Yale School of Medicine, these students work in teams composed of a nursing, medical, and physician associate student. They work together in a clinical setting throughout their prespecialty year learning fundamental skills in patient care, communication as collaborating health professionals, and quality improvement. This grant will help us build the platform to fully launch the new curriculum next year. A new school year always brings a sense of uplifting promise and excitement. YSN welcomes the most amazing students who begin their career as a Yale nurse. They leave as leaders who have learned, in the words of former dean Donna Diers, that “nursing is stage management, even choreography. In this secret world is a rich language and understanding of the human experience, not only of the patients we are mandated to serve, but of the range of human contacts with colleagues in all disciplines. Nurses know how the world of health service delivery works.”

This year there is palpable anticipation of our future as we work toward our mission of better health for all people as nurse leaders.

Holly Powell Kennedy, PhD, CNM, FACNM, FAAN Interim Dean and Helen Varney Professor of Midwifery

FALL 2015 YALE NURSING MATTERS 3 From left to right: Bridget Hutchens, Halley Ruppel, and Nancy Redeker

YSN SPOTLIGHT NEWS

Two PhD Students Selected for Prestigious Robert Wood Johnson Foundation Future of Nursing Scholars Award Bridget Hutchens and Halley Ruppel are among the 46 nurses in the United States this year to receive a prestigious Future of Nursing Scholars program award to support their PhD study. The Future of Nursing Scholars program is a multi-funder leadership program spearheaded by the Robert Wood Johnson Foundation (RWJF) that is increasing the number of nurses holding PhDs in Connecticut and around the country. More PhD-prepared nurses are needed to increase the number of nurse leaders, conduct nurse-led science and discovery, and educate the next generation of nurses, the Institute of Medicine has said. Hutchens intends to focus on maternal mental health and how to support women during the transition into motherhood. She is particularly interested in non-pharmacological methods of supporting maternal mental health, including exercise, sleep, meditation, supplements, and other modalities. Ruppel is interested in exploring critical care nurses’ use of Harold Shapiro Harold monitoring technology and the subsequent impact on patient Incoming Dean Moderates Forum care and outcomes. Understanding the impact of technology on nursing care and patient outcomes can inform both the education with U.S. Surgeon General of critical care nurses and development of better technology. The Future of Nursing Scholars program provides grants to at Yale School of Management schools of nursing so that they can provide scholarships to Last month, YSN incoming dean Ann Kurth, PhD, RN, MPH, FAAN, PhD candidates who will commit to completing the program in moderated a Leaders Forum with U.S. Surgeon General Vivek Murthy, three years. Hutchens and Ruppel will each receive an award MD, MBA, at Yale School of Management. Kurth and Murthy discussed of $75,000, as well as mentoring and leadership development some of the nation’s health programs, global health and the impact over the course of the PhD program. the United States can have on it, and how and why Murthy came to be the Surgeon General. The Surgeon General’s office is currently promoting walking and walkable communities through its Step It Up! program. The program YSN’s Beatrice Renfield Term Professor calls on Americans to be more physically active through walking, of Nursing Selected as Ambassador for the thereby significantly reducing the risk of chronic disease and premature death, and supporting positive mental health and healthy aging. “My National Institute of Nursing Research goal as Surgeon General is to build a culture of [disease] prevention in The Friends of the National Institute of Nursing Research (FNINR) America,” said Murthy. “That is the culture that our country deserves.” recently selected Nancy Redeker, the Beatrice Renfield Term Murthy’s message of a preventive culture was reminiscent of Professor of Nursing, as an Ambassador to the National Institute Kurth’s welcome speech to the YSN community earlier this summer. of Nursing Research (NINR). “YSN’s place in this potential health and health care revolution is more “The environmental, social, and political conditions that important than ever,” she stated. “We know we need to drive health influence the health and well-being of all Americans are served expenditures toward prevention, and we need to address chronic by exquisitely prepared nurses, reflected so aptly through disease by working in interprofessional teams with activated clients NINR,” stated FNINR President Michael Bleich, PhD, RN, FAAN. at the center of that care. YSN can be not just a national but a world “FNINR and our Ambassadors do this work with the health leader in nursing and health care.” and well-being of the public in mind.” This year, FNINR selected eight outstanding Ambassadors to join the 12 chosen in 2014. Ambassadors are selected from a national pool of applicants based on their abilities to advance public, professional, and policy-maker awareness of the critical research agenda linked to the NINR. “Nursing research has had an enormous impact on health and quality of life and will have an increasing influence in the future,” said Redeker.

4 YALE NURSING MATTERS VOLUME 16 NUMBER 1 Impact of Genetic and Psychological Factors on Blood Pressure Study Update It’s been one year since YSN Associate Professor Jacquelyn Taylor, PhD, PNP-BC, RN, FAAN, and Yale School of Medicine Associate Professor of Psychology in Psychiatry Cindy Crusto, PhD, were awarded a $3.4 million grant by the National Institute of Nursing Research. Taylor and Crusto expect more than 500 people (250 mother/ child dyads) to participate in the study, which will investigate the combined association of genetic, epigenomic, and psychological environmental factors on Student Is First-Ever Nursing Recipient of the blood pressure among African American mothers and young children. Currently, Paul and Daisy Soros Fellowship for New Americans more than 100 people (50 families) A new student at YSN this fall, Shinichi Daimyo, was named a Fellow by the Paul and Daisy Soros have enrolled. Fellowships for New Americans program. The program, which is the premier graduate school Throughout the remainder of fellowship for immigrants and children of immigrants, awarded Daimyo $90,000 toward his the study (the entire study spans five graduate school studies at YSN. years), Taylor and Crusto will collect Daimyo is the first-ever Soros Fellow in the field of nursing. Out of 1,200 applicants, he and data from each mother and her child 29 other recipients were selected based on their potential to make significant contributions to every six months for two years. They are U.S. society, culture, or their academic field. partnering with early childcare centers, Daimyo witnessed firsthand the trauma experienced by the Vietnamese boat refugee daycare centers, and schools that community when he was growing up in Los Angeles. While cultural norms told him to ignore serve children and their families, some mental health issues, Daimyo chose instead to focus on them. As a psychology major at the of which may lack needed resources University of South California, he volunteered in the Navajo Nation, and studied the psychological and may face stressors that impact consequences of the Cyprus problem in the Republic of Cyprus and Turkish Republic of Northern the families’ health and well-being. Cyprus. Recognizing similarities across these diverse settings, Daimyo was inspired to study Taylor and Crusto believe the results of mental health across cultural boundaries and countries. this study will serve as a platform for “My global mental health work has made it clear to me that nursing holds the key to development of interventions that target addressing the significant global burden of mental disorders in the poorest areas of the world,” lowering and preventing high blood said Daimyo. “I feel fortunate and am thrilled to be able to tackle this issue with two incredibly pressure early in life, thereby reducing talented, diverse, and accomplished communities.” health costs and extending lives. Ultimately, Taylor and Crusto hope to expand their understanding PhD Student Selected as of how genetic, epigenetic, and psychological factors like parenting Bloomberg Emerging Nurse Scholar stress, perceived racism and The competitive Lawrence S. Bloomberg Faculty of Nursing discrimination, and mental health accepted YSN PhD student Nancy Knechel ’15 to present impact African American mothers’ her research at the Emerging Nurse Scholars Forum which took and children’s blood pressure. place on October 26–27, 2015, in Toronto, Canada. More information about the study The Bloomberg Emerging Nurse Scholar program is an can be found on their webpage at invite-only program in which developing nurses come together http://intergen.yale.edu. to share research and connect with other nurses and doctoral students. Knechel had the chance to share her research while reaching out to others to collaborate, and help each other improve their ideas and further build upon nursing science. Knechel presented her research, titled “The Relationships Between Sleep Disturbance and Falls Among Veterans Who Have Experienced Strokes.” “Falls are a multibillion-dollar public health problem, and fall prevention is the focus of many local, state, and national policy initiatives,” she explained. “Presenting my research findings among such highly regarded scholars offered a unique professional growth opportunity that I believe was highly valuable as an early-career nurse scientist.”

Jacquelyn Taylor (left) and Cindy Crusto (right)

FALL 2015 YALE NURSING MATTERS 5 Exposure to Toxic Stress in Childhood Linked to Risky Behavior and Adult Disease

By Ziba Kashef iStock

6 YALE NURSING MATTERS VOLUME 16 NUMBER 1 ow a mother responds to her long understood that catastrophic events, stress affects behavior and lifelong health. baby’s cries can make a big difference in the such as experiencing or witnessing trauma, “Some of the effects of toxic stress are more H child’s ability to learn, develop, and thrive. have negative effects on children. But now immediate, and some are more delayed While a warm, supportive response can “people are beginning to realize that there responses that may not show up until later,” help the baby calm down and feel secure, is a spectrum of childhood adversity,” Sadler explains. a distant or angry reaction leaves the child says Garner. Family circumstances that to fend for herself in a scary world. Over were considered routine—such as divorce Adversity and Its Effects time, the lack of nurturing in the face of or separation, parental mental illness or No one knows how many children adversity in childhood can contribute to substance abuse, or growing up in poverty— experience toxic stress, but a growing “toxic stress”—a harmful level of stress that are anything but. “Whether the adversity is body of research on “adverse childhood can affect the child’s well-being well into catastrophic or more routine and mundane, experiences” suggest that it may be adulthood. the effect on the body is similar. There’s that common. In the late 1990s, the Centers for “Toxic stress is the prolonged common denominator of the physiologic Disease Control and Prevention collaborated experience of significant adversity,” says stress response,” he explains. with Kaiser Permanente to conduct the Monica Ordway, PhD, APRN, PNP-BC, When stress is positive or tolerable—a Adverse Childhood Experiences (ACE) Assistant Professor at Yale School of child gets an immunization or starts day care study. The research on more than 17,000 Nursing (YSN). Left unchecked, toxic stress —the proverbial “fight-or-flight response” adults found that those who had experienced in early childhood strains the stress response kicks in temporarily. The fight-or-flight abuse, neglect, or family dysfunction during system and even alters the developing brain. response, in which stress hormones rise childhood were more likely to develop “Over time, without intervention, toxic and inflammation increases, is healthy and unhealthy behaviors and serious disease stress will lead to an increase in adverse crucial for survival. But when the stress in adulthood. “What we found in the ACE health outcomes that would last a lifetime response is prolonged and not eased by study was that in a clearly middle-class for these children.” caregiver support, it becomes toxic to the population—which made it even more brain and other organ systems, according unexpected—a remarkable number of What is Toxic Stress? to a report co-authored by Garner et al., people had had toxic life experiences in The term “toxic stress” refers to stress that and published in Pediatrics. The part of the childhood that were still playing out roughly is not only overwhelming to a child but also brain that triggers the stress response a half century later,” says Vincent Felitti, not alleviated by the buffering of supportive (the amygdala) may become overdeveloped MD, an internist at Kaiser Permanente and adults. A concept developed by the National and overactive, while other areas of the co–principal investigator of the ACE study. Scientific Council on the Developing Child, brain that govern memory, learning, and More than one in four adults toxic stress describes the body’s response to decision-making underdevelop. “Most surveyed had experienced at least one negative events or experiences that are either worrisome,” says Lois Sadler, PhD, RN, PNP- of the childhood adversities, and one powerful, repeated, or prolonged. A child BC, FAAN, Professor at YSN, “is that areas in eight reported four or more ACEs, who routinely suffers abuse, neglect, or other like the prefrontal cortex, which is where including emotional, physical, or sexual forms of hardship, such as poverty, may be we do most of our thinking and decision- abuse; emotional or physical neglect; at risk for this harmful form of stress. making, may not become as developed as and household dysfunction (divorce or Toxic stress has gained attention in the other, more emotion-regulated parts of separation, domestic violence, parental recent years as advances in the areas of the brain.” The combination leaves young substance abuse, parental mental illness, and epigenetics, neuroscience, and life-course children with a chronically heightened stress an incarcerated family member). The most science have all pointed to it as a source response system. common ACE was physical abuse, reported of poor outcomes for children and adults. These changes in the brain’s by 28.3 percent of adults. “What we found “This is a rapidly evolving field,” says architecture and functioning can have in a general population was that in fact Andrew Garner, MD, PhD, FAAP, a primary far-reaching effects. In a child chronically ACEs were remarkably common and care pediatrician at University Hospitals exposed to toxic levels of stress, the changes remarkably destructive,” Felitti says. ACEs Medical Practices in Cleveland. He explains may result in chronic anxiety, learning are linked to both risky behavior and adult

iStock that experts in developmental science have delays, or poor social skills. Over time, toxic disease. According to one paper published

FALL 2015 YALE NURSING MATTERS 7 in American Journal of Preventive Medicine, “Toxic stress is the prolonged experience of significant people who experienced four or more ACEs were more likely to be at risk for adversity. Over time, without intervention, toxic stress will alcoholism, drug abuse, depression, lead to an increase in adverse health outcomes that would and suicide. They were more inclined to smoke, and be inactive and obese. Most last a lifetime for these children.” —Monica Ordway, PhD, APRN, PNP-BC disturbingly, those who suffered the most adversity in childhood were more likely to develop diseases such as ischemic heart or community level, notes Sadler. Inside the program, developed by Sadler and her disease, cancer, chronic lung disease, home, open conflict between parents, the colleagues at the Yale Child Study skeletal fractures, and liver disease. presence of transient or intoxicated family Center, Fair Haven Community Health The original ACE study findings were members, and exposure to violent media Center, and the Cornell Scott Hill recently confirmed by a follow-up study could undermine a child’s ability to feel Health Center in New Haven, is an released in late 2014 by the Center for Youth safe. What the science has demonstrated evidence-based intervention that begins Wellness and the Public Health Institute. is that the impact of these exposures, and with mothers at the prenatal stage. From The study report, “A Hidden Crisis: Findings the toxic stress that follows, is not benign. the third trimester up to age two, pediatric on Adverse Childhood Experiences in “When we start talking about changes in the nurse practitioners and clinical social California,” found that a majority of more way the genome works, the way the brain workers visit mothers—typically teenage than 27,000 adults surveyed, or nearly architecture is formed, that helps people parents—in the home environment to 62 percent, had experienced one or more begin to understand the way early childhood provide health and mental health care. types of childhood adversity. The research experiences are literally embedded in the By intervening early, MTB nurses target confirmed the link between four or more body,” says Garner, “and therefore strongly two generations—the stressed-out young ACEs and disease, such as asthma, stroke, influence behaviors, productivity, and health mother and later, her child. “It’s a double and depression. It also found that those down the line.” layer of trying to help parents understand who endured the most childhood adversity their own responses and their own were at risk for other poor life outcomes, Solutions to Toxic Stress underlying feelings that may be coloring including poverty, unemployment, and lack Child development experts may not be able the way they interact with their child, of health insurance. to eliminate the triggers of toxic stress— as well as trying to understand the child,” These data are mirrored by what nurse poverty, neglect, abuse—but they can help says Sadler. practitioners like Ordway have seen in support families from the prenatal stage Parents who are overwhelmed by their practice. She cites poverty, food insecurity, onward. “What’s the thing that tends to own challenges are often less equipped to and even maternal depression as examples prevent toxic stress? It looks like it’s safe, offer the care and support children need to of factors that contribute to childhood stable, and nurturing relationships,” says handle adversity. “Often caregivers have the adversity and toxic stress in families. Garner. With the support of a caring adult, a right intentions but they did not experience “Single parenthood can place financial child’s stress response can return to normal, positive parenting as a child themselves to strain and burden on the parent that often even in the face of significant adversity such prepare them to parent their own children,” increases their level of stress, which impacts as divorce or death of a family member. notes Ordway. A mother who grew up the child,” she says. Even in two-parent The presence of protective adults makes it experiencing toxic stress as a child may households, long hours and job insecurity possible for a young child to adapt to stress still be coping with the effects or have few can take a toll and interfere with the ability in healthy ways that facilitate growth and positive parenting examples to draw from. of the caregiver to provide the type of healthy development. “There’s an intergenerational issue here, supportive, responsive environment that One effective strategy for helping where they’re raising their children the would otherwise buffer stress. new parents build the skills they need to way they were raised, so there was often no Additional forms of adversity may buffer stress for their children is home role model to show how to sit and talk to include environmental factors like violent visits from nurses and other providers. the child about their feelings or emotions,” crime or gang activity at the neighborhood For example, the Minding the Baby® (MTB) Ordway adds.

8 YALE NURSING MATTERS VOLUME 16 NUMBER 1 Home visiting programs address experienced by children exposed to toxic The Role of Nurses these intergenerational issues. In the MTB stress are similar to what we see in children Nurses are already on the front lines in the program, through a process called “parental who experience sleep deprivation or poor battle against the negative effects of toxic reflective functioning,” young mothers sleep quality, leading to poor health outcome stress. From prevention, intervention, and learn to better understand the feelings, risk,” says Ordway. “One of the theories we treatment, nurses often spend more time intentions, and needs that underlie their have is if we can support parents to develop with patients in different settings and have own behaviors and those of their child. “It’s healthier sleep quality, better sleep duration opportunities to minimize the impact a gradual process because it’s a different for children, that may be a way of buffering of adversity on children and families. way of thinking about themselves and their the effects of toxic stress.” Whether they are registered nurses, nurse children than they have probably ever done To effectively address toxic stress, coordinators, nurse practitioners, or nurse before,” she notes. New mothers who reflect however, both Sadler and Ordway explain researchers, nurses across disciplines play not only on their own feelings, but also that multiple interventions are essential. a key role in identifying those at risk and on the developmental needs and emotions “There’s a need for different kinds of developing the most effective interventions. of their fussy babies, are better able to programs that fit the particular needs of To support families, nurses can also respond positively. “That helps them be families or communities,” says Sadler. Some work in interdisciplinary teams. “We’re more sensitive to what the baby might need individuals may have specific needs that really good at doing that as nurses,” notes or to try different things,” says Sadler. fit well with components or strengths of Ordway. “The most successful programs will Research on home visiting programs particular interventions. Certain families incorporate an interdisciplinary approach— shows they work. In a paper published last may need to participate in an intensive social work, nurses, physicians all together year, Sadler et al. found that children in the home visiting program, while others might working to identify how we can better MTB program are much more likely to benefit from a sleep intervention provided support these families.” develop secure attachments to their mother. in a pediatric or family primary care setting. Nurses can also have an impact by “What we’re hoping is that this secure “A diverse menu of interventions will be raising awareness and influencing policy. attachment in a high percentage of families most successful,” Ordway adds. “I think, as nurses, we also need to be very is going to work like a protective shield against Garner describes a range of possible active in changing some of the governmental the toxic stress that they are encounter­ing interventions that reflect a comprehensive policies around how we support families,” in their lives,” says Sadler. “That is, ‘yeah, public health approach—from evidence- says Ordway. One example, Ordway notes, scary things can be happening, but mom’s based therapies to treat those children is to advocate for policy change that would going to make it okay.’” Another well-known who have experienced trauma to targeted allow nurses to refer families with depressed home visiting program, the Nurse Family interventions that would screen and mothers because of the link between Partnership, has shown many positive results identify those at risk. Parenting programs maternal depression and adverse childhood for children and families. and early intervention programs can help outcomes. “That’s a policy that as nurses we Working with Sadler, Nancy Redeker, address the problem before children start can impact,” she explains. PhD, RN, FAHA, FAAN (YSN’s Beatrice to experience the effects of toxic stress, Renfield Term Professor of Nursing, such as developmental delays. Another References: Director of the school’s Biobehavioral public-health-oriented approach, he notes, Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Laboratory, and Professor at Yale School would be some form of universal primary Childhood, Adoption, and Dependent Care, Section of Medicine’s Department of Internal prevention that all children receive, such as on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic Medicine), and a pediatric sleep working social-emotional learning in school. “Our stress. Pedatrics, 129(1). doi:10.1542/peds.2011-2663 group, Ordway is exploring additional real long-term goal is to help kids build Sadler, L. S., Slade, A., Close, N., et al. (2013). Minding interventions that could be applied by skills so that when they have adversity, they the baby: Enhancing reflectiveness to improve early primary care providers, either in a medical deal with it in an effective manner,” he says. health and relationship outcomes in an interdisciplinary home-visiting program. Infant Mental Health Journal, home or in private practice. Specifically, “If we can somehow find a way to make 34(5), 391-405. doi:10.1002/imhj.21406 they are looking into ways to help improve adversity more tolerable or even positive so the sleep patterns of children and parents. those experiences are opportunities to learn “We know that the same health outcomes and grow, that’s what we’re trying to do.”

FALL 2015 YALE NURSING MATTERS 9 FACULTY Q&A Lisak Robert

Interprofessional Education at Yale: Breaking Down Historical Silos to Improve the Learning Experience and, Ultimately, Patient Care YSN faculty members Deborah Fahs, DNP, MSN, FNP-C, RN, Linda Honan, PhD, MSN, CNS-BC, RN, and Phil Martinez, MSN, APRN-BC, have been working with Yale School of Medicine (YSM) and Yale University’s Physician Associate (PA) program on an interprofessional educational program for medical, nursing, and PA students. Learn more about the program from Fahs, Honan, and Martinez, including its challenges, benefits, and why it’s necessary in health care education.

What is interprofessional education? How will the program impact the field of all to learn collaboratively, while still honoring Interprofessional education (IPE) is a health care and the health care team? the teaching of our individual programs pedagogical approach to shared learning The awareness that IPE plays a critical role in regarding the uniqueness that makes a nurse in the laboratory, classroom, simulation preparing future health care professionals for a nurse, a physician a physician, and a and/or classroom setting among students collaborative practice has been recognized physician associate a physician associate. from two or more health professional for years, and research studies link positive schools with the aim of improving teamwork, patient outcomes with improved coordinated How will the program enhance the nursing communication, and collaboration. and collaborative practices among health student’s educational and clinical care providers. experiences? What are some direct benefits of the Without this program, students have program? What are some of the challenges you episodic, unstructured opportunities to learn The students’ shared learning commonalities encounter with the program? How do you together, often relegated to chance rather rather than “differences” will make a plan to address these challenges? than deliberate, thoughtful organization. difference in changing the culture of health Getting buy-in from all three professional Our students have noted that their IPE fosters care. For faculty, there is comfort and pride schools was a major hurdle. It is also cooperation among team members and aids in being a member of an interprofessional challenging to develop and maintain a culture in eliminating issues of competition, and they team from YSM, the PA program, and among students and faculty who appreciate came together realizing their mutual goal YSN. And clinical sites have the joy of the worth of shared learning. Securing clinical of patient-centered care. educating energetic, committed students sites for the now 120 students has been one who bring a fresh lens of openness and of our greatest challenges. We have made a Can you name one “ah-ha” moment when curiosity to the units. concerted effort not to approach preceptors you witnessed how the program would who already participate in Yale clinical positively impact the field of health care What is unique about the program? education. As we identify these challenges, and the health care team? We are able to train three disciplines of we work them out as a team on a case-by- Witnessing the energy, commitment, and health care providers together from case basis. We are cognizant of the fact that desire of our students to work together the very beginning of their health care if our interprofessional students do not is nothing short of exhilarating. And it is an education. It allows us an opportunity observe us, as core faculty, functioning as an “ah-ha” moment that revealed to us that our for our students to learn simultaneously interprofessional team, our efforts are futile. students themselves are ready for and with their physician and PA colleagues wanting IPE. while they are all still forming their Why is it important that we educate our professional identities. We are capitalizing students (nursing, medical, and PA) in Where do you hope the program is in the on their similarities by teaching important an interprofessional environment? What next five years? clinical skills like history taking and will happen if we don’t? We anticipate that the program will go live physical exam together while at the same When there is mutual respect and open for all three schools next year, doubling our time teaching them the importance of dialogue, everyone benefits. By capturing the numbers of students from 120 to 240. teamwork, quality and safety, and culture. attention of students early, while they We are excited for the future and are so very In addition, it is a chance for faculty from are still learning about their own roles in the thankful for the support from each of our YSN, YSM, and the PA program to work health care system, we can share with them deans and senior administration. We hope collaboratively to learn about the history the need to work together not only to solve that our team of faculty from each of the and nuances of each school. We have worked the problems of today, but also to help effect schools will continue to work to help mold diligently to learn more effective ways to change in the future as they become the next the future of interprofessional education work together outside of the historical generation of health care leaders. at Yale. For now, however, it is time to teach silos that have separated our schools, and If we choose not to educate our physical assessment to a group of nursing, ultimately we believe we also have become students interprofessionally, it will only medical, and PA students who are all eager to better teachers and health care providers serve to worsen the delivery of care in learn from us that the cardiac exam each because of it. a system already overwhelmed and of them will do time and again in their careers fragmented. It is the perfect time for us is one and the same.

10 YALE NURSING MATTERS VOLUME 16 NUMBER 1 GETTING TO KNOW YSN Dean Designate Ann Kurth ’90

It’s no secret that Yale School of Nursing’s incoming dean, Ann Kurth, PhD, RN, MPH, FAAN, is well equipped to propel the school forward as a leader of modern academic nursing. What many may not know is where her passion for nursing, global health, and science originates, and how it has guided her professional career.

“My own journey in nursing began with a story and loss that is still all too common in the world, especially in low-income countries— the death of my great-grandmother following childbirth—in what is now the Slovak Republic,” explained Dr. Kurth. As a result of her great-grandmother’s passing, her great-grandfather immigrated to the United States, which Dr. Kurth credits as providing her with the opportunity for an Ivy League education. “Her preventable death and his loss reverberated in my decision to come to Yale to learn the clinical skills of nurse-midwifery.” As the daughter of a nurse and doctor (mother and father, respectively), Dr. Kurth was exposed to health disparities well before she began her education at YSN. Her parents volunteered extensively, including with the Navajo Nation and in Latin America. Through these experiences, she witnessed health care disparities in general, and the contribution of nursing in particular. Following her graduation from Princeton University, Dr. Kurth Sorel Leo was awarded a fellowship established by Marie Curie’s daughter, had the chance to be part of a new Department of Global Health. to work in Malawi evaluating an agricultural project for its impact on She now serves as Treasurer of the Consortium of Universities in the nutritional status of children. While there and weighing thousands Global Health, a coalition of 140 leading universities focused on the of infants, she realized she was not properly trained to care for them. contribution of academics to improving health worldwide. At the Dr. Kurth enrolled at Columbia University, where she earned her national level she is a member of the U.S. Preventive Services Task master’s in public health in population and family health. Her desire to Force, which sets prevention and screening guidelines for primary care enhance her clinical skills brought her to YSN. practice in the country.1 Dr. Kurth arrived at YSN during the height of the HIV epidemic “From the first glimpses of HIV to being part of national advisory in the city. The disease was devastating to communities like the Dixwell bodies evaluating billions in funding to improve the lives of millions, Avenue neighborhood in New Haven, where she lived as a YSN student. the lesson I’ve learned is that the health of individuals, communities, “We owe so much to that period of tragedy and activism,” she said. and countries can be improved,” stated Dr. Kurth. “Nursing and The driving principle across her research career is: how do we midwifery are a central part of that evolution. As nurse educators deliver the most effective health care in the most efficient way? “The and scientists, we have to keep demonstrating how.” science that I’ve aimed for is identifying best practices to prevention Until she assumes her role as dean of YSN in January 2016, and care, and working to scale them up into the health system level,” Dr. Kurth is professor of nursing, medicine, and public health at New she explained. While there has been significant progress in HIV treat- York University (NYU), founder and executive director of NYU College ment and prevention, for example, Dr. Kurth acknowledges that there is of Nursing Global, and associate dean for research at NYU College of still a way to go. “We need to disseminate what works so that we can Global Public Health. turn the tide of the epidemic, but we can get there only if our nurses and Once at YSN, she looks forward to working collaboratively to midwives—the largest cadre of health professionals everywhere—are reinvigorate the school’s research, develop clinical practice and faculty, actively engaged with communities in health care models.” enhance the student experience, increase resources and partnerships, After YSN, Dr. Kurth assumed several leadership roles, including and support an optimal workplace culture. president of the Association of Nurses in AIDS Care. In this role, “We can help improve the lives of many—including stopping she explains, she met some of the best nurses she has seen in her women in childbirth from dying around the world—by educating career so far. In addition, she took on another leadership role at a more midwives and nurses, and more nursing leadership, as we do national HIV non-governmental organization, which made her aware so well at Yale.” of the importance of advocacy. As an elected member of the Institute of Medicine, she was involved in evaluating the global PEPFAR HIV Siu1 AL, Bibbins-Domingo K, Grossman D. Evidence-Based Clinical Prevention in the program. At the University of Washington, where she began her Era of the Patient Protection and Affordable Care Act: The Role of the US Preventive academic nursing career after earning her PhD in epidemiology, she Services Task Force. JAMA. 2015 Sep 30:1-3.

FALL 2015 YALE NURSING MATTERS 11 CLASS NOTES

Jean Bradley, 1952 I am my husband and I did for 30 currently residing in an years. I counsel clients on weight independent living center in issues. I have been operating Chester, CT. At 87 years, I am this for 10 years, working two thankful that I can be of help full days a week. Not thinking Joy Ruth Cohen ’63 Bette L. Davis ’71 to some of my fellow residents of retiring. I still attend ASBP who are not so fortunate. My meetings. areas. I continue to fundraise who graduated in 1955 from nursing skills are outdated, and and connect, working with North Carolina’s first four-year Gail Elaine Harwood, 1956 Episcopal churches. I have five bachelor of science in nursing I am envious of the younger My husband and I are in our 80s, grads that work in such exciting grandchildren. program. I am among those in reasonably good health for our graduates in the book who and challenging hospital and age, and still living in our home. Joy Ruth Cohen, 1963 My community settings. YSN has husband, Howard, died in May share memories of their journey We will celebrate 53 years of through their undergraduate come a long way since 1952 marriage in September! 2012. In February 2014, I sold when I graduated. our home in Clinton, CT, and years and how this new Anna Haupt, 1957 Healthy relocated to Lunenburg, MA, approach to nursing education Ardis Wagner, 1952 Medicine and happy, and celebrating my affected the rest of their lives. is big in my family. My recently to be closer to our daughter, 60th wedding anniversary this Dr. Cynthia Cohen. She is a My own memoirs also include deceased husband was a Yale summer. my graduate school years at Yale MD graduate. My son is an MD, small animal veterinarian and a Marjorie Lewis Wallace, 1957 nationally certified sign language and its influence on my life and my granddaughter will graduate career after graduation. med school in 2016, and my I am retired from working in interpreter. I have a lovable daughter and daughter-in-law nursing homes and live in a 8-year-old Boxer, Monty (the Maureen Doran, 1971 It’s been are actively nursing. At 92 years retirement community with my Wonder Dog), and a personality- four years since returning from I am enjoying family, church, husband in Rochester, NY. We plus 8-year-old Sheltie, Misty Botswana and two-plus years in exercise, and lectures at nearby do not travel out of the area very Sashay. I am active in fields the Peace Corps. I reopened my college. Life is good! far these days. I decided long of alternative care and am private mental health practice at trips on the road are a bit much restarting my “Hypnosis Works” a half time pace. Great! Enjoying Lois (Podie) Brunton, 1953 at our ages. I am the driver for business. I continue to be an family is wonderful...including Nursing is inbred! At these later the two of us. Our three children active distributor for Shaklee granddaughter Avie, who is 5 years, it continues to provide and three grandchildren are all products. years old in Cambridge, and help to neighbors, friends, and very busy with their lives and all Brennan, who is 1 year old in family. Angela McBride, 1964 I am live in other states. When they part of a “Lessons in Leadership” Oakland. Anyone headed west, Connie Callahan Hornickel, 1953 visit, our children are in touch video developed in March 2015 come see us in Denver! At age 87, I am blessed to be in with work via their smartphones. by the Gordon and Betty Moore Mary Geary, 1974 I have excellent health, volunteering For decades I kept in touch Foundation, available at: been elected vice president in the community, The City with Mary Stone Brodish and http://www.moore.org/programs/ of the board of trustees of Mission, and my church. Recent Barbara Holcenburg Schneider patient-care/betty-irene-moore- St. Francis Medical Center, a corneal surgery was really at holiday time, but that has nursing-initiative/betty-irene- Trinity Health System hospital life-changing, best vision I have stopped. I send best wishes to moore-speaker-series. in Trenton, NJ. My appointment had in 20 plus years. Maybe the my classmates. I am to be inducted as an two years ago to the board is lessons learned at YSN in the Dottie Bittner, 1957 Mimi Honorary Fellow, NLN Academy part of a national movement 1950s including nutrition and Dye ’58 published a book, of Nursing Education, on promoted by the Robert Wood regular exercise have been worth Assumptions Can Mislead, October 2, 2015. Johnson Foundation to foster it (plus some magic genes!). about Ida Orlando’s work. Bette L. Davis, 1971 I am happy the appointment of nurses as Adelia (Dede) Robertson, 1955 Jane Ergood, 1958 My husband, to share with my 1971 classmates community members of boards, I just had my seventh great- Bruce Ergood, MRE (YDS), PhD and all YSN alumnae/i and recognizing the breadth of grandchild, am still involved (retired Ohio University faculty, faculty the news of publication clinical and leadership skills that decorating CBN and Regent two LA Fullbrights in Argentina), of the following book: Ahead nurses can bring to a hospital University, and am participating and I have been training rural of Our Time: Chapel Hill’s First board. in Operation Blessing missions. health workers in Honduras for Nightingales. Judy Flanagan, 1975 I’m trying My husband is still active doing a 10 years. I was nursing director I was in the first class of to stay cool, which is not easy in daily TV show, and we stay busy! in Florida and then exec. in 27 female students admitted a hot, humid climate. Still, we’ve Jeanne Kates Johnson, 1955 southeast Ohio for seven county in 1951 to the University of had very little severe storms I am still working. I started a MIC projects and feel as though North Carolina’s new School these last few years. I’m grateful small clinic to continue the work locals can do great work in poor of Nursing and among the 17 for that. I have two line dance

12 YALE NURSING MATTERS VOLUME 16 NUMBER 1 “ Given what nurses see in home care—what they learn about the barriers to adherence individuals struggle with—it strikes me that starting one’s career in home care is incredible preparation for any other kind of nursing.”

ALUMNA SPOTLIGHT Adele Pike ’84: The Unique Perspective of a Home Health Care Nurse

Adele Pike traveled involved in case management, patient onstrated achievement or distinction in their an unconventional teaching, crisis intervention, and other career, their contributions to their communi- path following her hands-on tasks.” ties, or their contributions to YSN. Pike was graduation from Home care nurses see their patients in a honored at a banquet during reunion weekend. YSN in 1984. Unlike way that no other provider in the health care Pike is currently the director of educa­- many of her fellow system is able to. They see patients managing tion at VNA Care Network and Affiliates. She graduates, Pike did (or not managing) illness and recovery in the has worked with this large home care agency not immediately context of their day-to-day lives. This is an for the past 18 years, as a field nurse, team begin working as a incredible privilege and responsibility. As a manager, district director, and now head of a nurse in a hospital. result, the nurse has to rethink and adjust her 17-member education department. During Instead, her first job was in home health care. or his approach to care. “We have to move this time, she has implemented a number Home health care includes a broad away from the hierarchical tendencies that, of innovative programs. In 2004, she range of care and support services for those as nurses, we adopt in the hospital,” she said. established the VNA’s first academic-service who are recovering from a hospital stay, are “We can’t tell the patient when to take his or partnership with Boston College, which ran disabled or chronically or terminally ill, and her meds or what to eat; we can’t put alarms until 2010. Pike then oversaw the establish- need treatment and/or assistance with the on a bed or chair as a way to help prevent ment of an academic-service partnership essential activities of daily life. Pike explains falls. We have to engage with the patient in a between the School of Nursing and Health there are numerous challenges with home way that allows us to provide care according Science at Simmons College and the VNA. care, including providing care autonomously, to his or her goals. Early in our relationship In both of these partnerships, hundreds of with no peers or “supply closet” in the with patients we often have to do a lot of nursing students have been exposed to home immediate vicinity. Limited basic resources work helping them identify their goals for health nursing by caring for frail elders at like running water may be in short supply, care.” While the different setting requires assisted living facilities under the direction of patients may be struggling with financial adaptability, it also provides the nurse with a preceptors from VNA of Boston. insecurity and/or tenuous family support, and unique perspective. “You witness people’s An exciting outcome of these partner- community services are often hampered by resilience and vulnerabilities, regardless of ships has been the establishment of a New long wait lists. In addition, there are logistical socioeconomic standing.” Nurse Residency Program in Home Care at challenges like weather emergencies, lack of This notion of equality in health care is the VNA. Now in its fourth year, the program cell phone service, poor connectivity, traffic, emblematic of YSN’s mission of better health admits five to eight newly graduated nurses long distances between patient homes, and for all people. Pike credits YSN with providing a year and provides them a six-month less than optimal communication between her with the foundation to be the best nurse orientation and onboarding experience prior multiple health care providers. “Working as a she can possibly be. Virginia Henderson’s to their becoming fully fledged home care home care nurse demands incredible definition of nursing and her framework of the nurses with the agency. Pike acknowledges creativity and problem solving,” stated Pike. nurse’s work being to help patients restore that there is a myth in nursing that new grads “It’s the hardest job I’ve ever done, but I could their ability to meet their basic needs guide need two years of inpatient medical-surgical not go back to working in an institution.” her practice. Donna Diers’s influence on Pike experience prior to moving into home care. Following Pike’s first job in home care is strong. Diers instilled in her the habit of “Our program should be putting the myth after graduation, she worked as an intensive ensuring she has her data when making an to bed,” she said. “Given what nurses see in care unit nurse at a National Institutes of argument. home care—what they learn about the Health clinical center for three years. She “The faculty at Yale pushed us to get barriers to adherence individuals struggle then moved to Boston and worked as a published before we left—then you knew you with—it strikes me that starting one’s career clinical nurse specialist at Beth Israel Hospital could do it,” Pike said. “There’s a legacy of in home care is incredible preparation for for 10 years. When the health care financial really strong women who changed the face of any other kind of nursing.” crisis hit, Pike saw an opportunity to move nursing, and in the process changed the face One of Pike’s hopes is to encourage back to home health care, where she had of health care.” more recent graduates to work in home more control over her practice. Pike’s dedication to the field is evident health care. Through these programs, Pike As one can imagine, the patient-nurse to many. In spring 2015, she was recipient of has witnessed great success with new relationship is very different in home care the Outstanding Innovation Leader Award graduates. She would love to see home than in the hospital setting. A significant from the Visiting Nurse Association of health care funding at least preserved if not part of Pike’s job as a home care nurse is America (VNA) for her creative approaches increased, as home care is an integral part establishing a collaborative relationship with to developing and implementing programs in of how the health care system helps prevent the patient. “You are now on the patient’s turf, the home health field. During that same time, illness and injury, reduce hospitalization, and he or she is driving the bus,” she explained. she was named YSN’s 2015 Distinguished keep patients in their communities, and “As a home health care nurse, you are heavily Alumna. Recipients of this award have dem- reduce total medical expense.

FALL 2015 YALE NURSING MATTERS 13 Tracy Wittreich ’80, center, at the 35th Yale reunion with classmates Heather Reynolds, left, and Dean Judy Krauss. classes and two chair yoga through first quarter 2017. I am classes every week, and both are enjoying part-time work until so much fun. I volunteer at the that time and look forward to St. Vincent de Paul free pharmacy many more years of international in town as a screener. We are travel, Rocky Mountains hiking, able to provide medicine for and time with family and friends. the less fortunate, which is very Kathleen Hoppe, 1976 I am rewarding, and the 65 other retired and involved in the Sarabeth Friedman, 1978 I am group going to teach physicians, volunteers are such nice people. following activities: volunteering living and working in Denver pharmacists, and nurses. I belong to several quilting at the White House’s Office of along with many YSN grads. Tracy Wittreich, 1980 groups in this region. We make Presidential Correspondence, I think there is about 10 of us! I celebrated my 35th Yale a lot of quilts to give away, volunteering with SHE DC (DC I work part-time, so I have time reunion with classmate Heather and there are also many nice mayor’s women’s empowerment to ski, bike, swim, quilt, and Reynolds and Dean Judy Krauss. people at the events. Right now group), focusing on middle write my memoirs! I’m working I am still working full-time as a I’m taking a CD course from school girls in Ward 6, a member with the Department of Public senior midwife at Obstetrics- the Great Courses called “The of the Jewish Mindfulness Health and also at Denver Gynecology and Infertility, and African Experience: From ‘Lucy’ Center, developing a support Hospice as an RN. I’m about to I have delivered over 4,000 to Mandela.” It’s interesting. I phone line and peer support become a grandmother for the babies at Yale-New Haven may be old, I don’t know. Let’s group for socially isolated first time. The baby will be born Hospital. I recently received an see, I need to take care of my congregants at my synagogue, in Cambridge, MA, with award from the March of Dimes home (not as good as I would playing piano and singing, the assistance of the CNMs at for my work with the “March have liked after retirement), swimming, and running/walking Mt. Auburn Hospital, most of for Babies.” My team, “Tracy’s enjoy more time with Ed, and each week. I continue to be a whom were students of mine Team,” was a Top Ten State of CT sing in the choir. political junkie. at YSN, so I am happy and Family Team. Susan (Behrenfeld-Zekauskas) Karen Suchanek, 1977 I worked confident to have them help! Candace Gortney Moore, 1981 Marple, 1975 I have been for 46 years with children, Andree de Lisser, 1979 I retired from the Navy and am involved in clinical research mainly in child psychiatry. I also I graduated from Case Western living in Atlanta. for the past 25 years and have worked with adults and families Reserve University on August 15 owned my own site since in psychiatry. This was hard with my DNP, so that’s big news David Coller, 1983 I am 2000. We have specialized in work while I was also married for me! I will be submitting a currently in Shelbourne, Nova cardiovascular and metabolic and raising two children. In manuscript about my capstone Scotia, Canada, heading home drug studies and have been psychiatry it’s hard to take time research on chronic sorrow in from a 3,000-mile cruise to involved in bringing to market off, as clients need you and the elderly for publication. As Newfoundland and back on my many of the current drugs that call on voicemail if you aren’t you know, I currently teach full schooner Renegade. Perhaps have revolutionized cardiac and available in the office. After time at YSN and am thoroughly back to work in the fall, perhaps diabetes care. I decided that age 65 my friends convinced enjoying being back at YSN in to fully retire. We’ll see. the age of 70 was a good time me I was really burned out so I that role. Susanna Peyton, 1983 Our four to retire and stopped accepting started thinking of retirement. children are almost grown, new studies in December 2014. Deborah Boyle, 1979 I did, and I had two knee only a senior in high school left. We will complete all current I presented at the International operations in New Haven, CT, I imagine many others in my age contracts, which will take us Society of Nurses in Cancer and waited for my husband to Care conference in Vancouver, group are having this transition retire in a few years. We then Canada, on compassion fatigue too! I enjoy part-time work, moved to South Carolina, as in oncology nurses. I published two to three shifts a week, as the weather is beautiful, and an article in the July 2015 issue a staff nurse on the inpatient we live on an isolated island 20 of Nursing entitled “Compassion behavioral health and addictions minutes from the beach. My Fatigue: The Cost of Caring.” In care service at Emerson children are older, and I have one addition, I was just appointed Hospital, Concord. Separately, grandchild in Massachusetts. as a trustee of the Oncology I’ve been involved in developing We are leaving for the wedding Nursing Foundation Board. I a course for third-year medical of my 35-year-old up north next will be volunteering in Vietnam students at Boston University week. My life is more relaxing for two weeks at their national and Tufts, and master’s— now. There are many things to cancer hospital in Hue; I will preparing students at Simmons. do in Charleston, and I still sing be the only nurse on a team of The course is Operation House in a choir. an American and Australian Call (operationhousecall.com)

14 YALE NURSING MATTERS VOLUME 16 NUMBER 1 Beth Blish Genly ’85 (left) and Emily (Florian) Tynan ’92 (right) and is hosted by The Arc Oncology at the Children’s Sara Fisher, 1990 I love my role and best wishes to my former of Massachusetts. It allows Hospitals and Clinics of as a psychiatric clinical nurse classmates. families to teach professionals Minnesota where I have been specialist consultant to General Emily (Florian) Tynan, 1992 about living with intellectual/ in charge of many educational Medicine at Massachusetts I am the sole proprietor in developmental disabilities (IDD). projects including directing the General Hospital. I support private practice that services We use a combination of parent partnership with StoryCorps nurses and physicians in the care clients’ behavioral health across and self-advocate classroom Legacy (NPR) to collect the of medical patients with complex the lifespan. In addition to instruction, home visits, and a oral histories of families of psychiatric and behavioral my practice, I work with the website for resources and children with sickle cell and issues. I am also a long-time center for geriatric and family discussion. Our families bleeding disorders. I am also in psychiatric nursing faculty psychiatry. Our oldest child represent a wide array of IDD my last year of a PhD program member at Simmons College. will enter his second year of diagnosis and experience, and at the University of Maryland I have enjoyed mentoring a YSN college, where he is studying they do a great job of naturally in Nursing (ABD). student and look forward to engineering. My daughter will teaching about people, not just Beth Blish Genly, 1985 doing so again. I was married be a sophomore in high school, diagnoses, supports, and good Although I loved nurse- nearly three years ago to both public and the CREC care. Although it is all too midwifery with my whole heart Vincent, and we live happily on Greater Hartford. brief as a training, our students Boston’s waterfront with our and soul, ultimately, burnout Greta Hart-Hyndman, 1993 have been very enthusiastic. took its toll. This experience 15-year-old Australian shepherd, Teaching about this subject Opal. I would love to hear from I received my DNP from drove me to search for better the University of Wisconsin- is rarely seen in professional answers, for myself and for my classmates—many happy, schooling, where students may hilarious memories! Milwaukee in May 2012. Last my colleagues and students. year, I published a paper in have exposure to a specific I teamed up with a naturopathic Karen Merrey, 1991 After diagnosis or clinical challenge, Violence and Victims called physician to comb the medical YSN, I never worked as a nurse. “Factors Associated with but no general training in this literature, and based on the I got an MPH in international area. Last fall The Arc of Mass Increased Risk for Lethal research, we have created a health at Harvard, then Violence in Intimate Partner presented me with the Allen robust, evidence-based system. returned to Sri Lanka to be Crocker, MD, Award for my Relationships Among Ethnically I am excited to report, about a with my family. While there, Diverse Black Women.” involvement in the program, year ago, we went on to co-found the only health-related work a wonderful honor. In fact, my a consulting company that helps I did included: (1) compiling Annette Hatch-Clein, 1994 interest in this work pre-dated employees and practitioners a directory of organizations I have been practicing as an FNP the fact that our first child fight burnout. These days, I love involved with AIDS work for at Eastern Maine Medical Center has Down syndrome. When I the life of an entrepreneur, with USAID, and (2) being a board in the Bangor, ME, area since originally applied to YSN, I was all of its ups and downs. member of the Community Front 1994. I have a very busy practice intent on working in mental with over 1,400 patients, many Catherine Borkowski Benoit, for the Prevention of AIDS. In health with those who have IDD, that capacity, I organized four of whom I have known since but found that specific training 1987 I am beginning my third they were born, and others who year of practice as an APRN at conferences with the purpose of was only acquired in the field. updating Sri Lankan public health started with me when I was This year YSN will try a version Gastroenterology and Digestive working in a middle school, who Wellness in Pawcatuck, CT. laws; the recommendations were of OHC with the PNP class. Very submitted to the government. have now started their own exciting! Doug Brown, 1987 I recently In 2000 we moved to South families. Other patients I have edited an issue of the online Africa, where I continued doing had have passed away. It is a journal Interhomeopathy. It volunteer work. We returned to true family practice, working can be viewed at http://www. the United States after 10 years with patients ages 2 days to interhomeopathy.org/april-2015. in South Africa and now live in 96 years old. Working with my My wife Beth and I have become North Carolina. My husband patients gives me “my lift” by foster parents and are caring is semi-retired but continues taking care of them. I also have for a 9-year-old girl...it is an working as a consultant in the wonderful coworkers who make adventure of the heart! field of water management. my practice enjoyable. Karen Chudoba Kachoulas, 1988 I volunteer for the Interfaith I haven’t won any awards I am a clinical nurse liaison at Council for Social Services and nor do I hold any hospital or YNHH for my infusion company, expect to begin tutoring children state positions, but working Walgreens Infusion/OptionCare, in reading when the schools every day in the trenches brings Jocelyn Gorlin, 1984 I am a and will be a newly appointed reopen. My son is now married, its own rewards. I can claim that pediatric nurse practitioner in preceptor this coming fall for and we have one grandson, who I received a postgraduate CNS in the Department of Hematology/ YSN GEPN students. is 6 months old. Warm regards psych-mental health in 2002, as

FALL 2015 YALE NURSING MATTERS 15 Sharon Eck Birmingham ’99 (left) and Dilice Robertson ’08 (right)

DNP at Fairfield University in May 2015. I recently opened a part-time private practice— Lifespan Collaborative Services LLC, seeing children up to older adults—doing psychiatric well as came in second place in Karen (Martin) Hammond, 2000 practitioner-owned recovery evaluations, psychotherapy, a yearlong road race series last I have been working in a practice—currently accepting and medication management. I year at 52! I am a mom, wife, collaborative practice with referrals. Please visit the website currently work for Connecticut (of Lee Still), sister, aunt, Medical Oncology/Hematology www.oceansiderecovery.org. We Mental Health Center at Manson coworker, friend, and neighbor from 2000 to 2012. I have been are also listed on Facebook! Youth Correctional Facility of many! My kids (15 and 17 part of the clinical faculty for I’m really excited to start this doing psychiatric evaluations years of age) are active in sports YSN since 2003. I joined YNHH adventure and put my 20 years and medication management and art. My dogs may be my at Smilow Cancer Hospital- of psych experience to good use. for youthful offenders ages best friends. Waterbury in 2012. I have been I have two grown boys, 21 and 14–22 and per diem at Yale-New My word to the new class married to Robert since 2011 and 26. My 21-year-old recently had Haven Hospital on the inpatient of NPs is that you can make a moved to Litchfield in 2014. a son named Alex James, who is psychiatric units. difference if you work hard! Christa Hartch, 2001 In 3 months old, which makes me a Sarah Owens, 2010 Sarah Stephanie Calcasola, 1995 September 2014, I accepted an young grandma at 48 years old! and Michael Usher welcomed At the 23rd Annual Health assistant professorship at the Life is good. daughter Auda Josephine Forum and American Hospital Norwalk Community College Enyo Dzata (Vivian Dzata), (8 lbs., 15 oz.) on August 7, 2015. Association Leadership Summit, School of Nursing and Allied 2007 I’m still reminiscing of the I presented on alternative Health. I am teaching first-year wonderful dinner and company payment models, “Bundled students in the Nursing program from the Philadelphia networking Payments to Align Providers to and enjoying the role very much. event YSN coordinated with Increase Value for Patients.” I am Courtney Marshall, 2003 (then) Dean Margaret Grey back director of quality and medical Over the past five years I in April. Here are some photos management at Baystate have gotten married, had two of our baby girl—Zoè Grace Medical Center, Springfield, MA. children (Madeleine, 3 years Adwoa Smith—born on May 4, Lynn Pittsinger, 1998 I am old, Samantha, 16 months old), 2015, weighing 9 lbs., 11 oz. She currently serving as the director earned my post-master’s and is a joy! of pediatric emergency services became a psychiatric nurse at Hasbro Children’s Hospital/ practitioner, and just opened Rhode Island Hospital in my own private psychiatric NP Providence, RI, and am also practice in Crofton, MD. I miss serving as a per diem urgent care being a midwife, but I am still Bronwen Peternell, 2011 pediatric nurse practitioner for working with women and helping I just reached my one-year Harvard Vanguard in Wellesley, them be happier, healthier anniversary at One Medical MA. In addition, I am making a people. Group as a family nurse serious effort to complete my Emily Haozous, 2003 I will practitioner, practicing primary DNP at UMass Amherst…and be inducted as a Fellow in the care and sports medicine. My will let you know where I land in American Academy of Nursing husband completed his medical the next edition of Class Notes. in October 2015. residency, and we’ve recently Sharon Eck Birmingham, 1999 Michele Litwin, 2004 I’m settled in Santa Cruz, CA. I am Sharon and her husband Andy seven months pregnant with a certified psychiatric nurse Jessica Theorin Holm, 2008 are relocating full-time to their baby #1. It’s a boy! practitioner and a certified Jess, Noah, and big sister Elsa coastal home in Beaufort, NC. As addictions registered nurse– welcomed Axel Glenn into their Stephanie Tillman, 2012 In July an entrepreneur, she continues advanced practice. I recently family on June 6, 2015. Axel was 2015, I began my three-year to offer new Chief Nurse Officer started a business for patients born at home, into the hands of term as secretary on the board coaching and is currently in who have substance abuse his dad and two midwives. of directors of the American the data collection phase for or behavioral health issues. College of Nurse-Midwives. Dilice Robertson, 2008 Since the National Nurse Scheduling The practice is Oceanside In August 2015, I celebrated graduating, I have a 5 year-old & Fatigue Study (NNSS). They Recovery LLC and is located in three years of my blog “Feminist son—Aiden. I completed a welcome all visitors to Beaufort! Niantic, CT. It is the only nurse- Midwife,” which attracts

16 YALE NURSING MATTERS VOLUME 16 NUMBER 1 hundreds of readers each month for hospitalized older adults, and is followed by over 4,000 and community health and UPDATE FROM THE YSNAA BOARD Facebook users. educational presentations for As I enter my second year as Elizabeth Farrington Forkel, older folks throughout central New York. President of the Yale School 2013 I got married on May 30, of Nursing Alumnae/i Association, 2015 and started a new geriatric Alexis Dassler, 2014 My I am thrilled to share some exciting NP position with Harvard colleagues voted me as initiatives. Vanguard Medical Associates– Seattle’s top medical provider Atrius Health in Cambridge, MA. for patients with sickle cell We continue to organize and support our YSN Mentoring Kate Kelly, 2013 I’m living in disease, according to Seattle Program, which is now in its third Northampton, MA, with my Metropolitan Magazine’s 2015 year. Last year we had a total husband and toddler (I was “Top Doctors” survey (http:// of 150 student-mentor pairs, and quite pregnant when we walked www.seattlemet.com/doctors/ we hope to see an increase in across the stage for graduation) find/#?query=dassler). participation this year. This program is an opportunity in a house we bought in summer Eliana Aaron, 2015 EMA Care for YSN students and graduates to be paired for the duration 2013. I work at Northampton (http://www.healthcareisrael. of a student’s time at YSN. Mentors are available for Area Pediatrics, where I was a com) provides healthcare encouragement and support throughout school, career and student my last year at YSN. coordination, referrals, on-call networking advice, and CV review. We have received great I love primary care and love services, medical translation, and feedback from both students and mentors about the experience. working with the very dedicated patient advocacy for English- We will also continue to plan events throughout the year for NPs and pediatricians at this speaking tourists, residents, YSN students, including our annual speed mentoring event, practice. This spring I had the and gap-year students in Israel. a career panel event, negotiation techniques, and CV review. chance to visit 2012 classmates The purpose of this business We welcome ideas for new programs! This year our speed Lisa (Fishlin) Gallagher in San is to provide services that are mentoring event will take place on December 3, 2015, Francisco and Chris West and currently lacking in the Israeli in conjunction with the Transition to Professional Practice family in Arcata, CA. healthcare industry for those (formerly Contexts of Care) class required for second- who are not covered by national Jenna Bristol, 2013 I recently year master’s students. If you are in the New Haven area and health insurance or those who started working with DaVita would like to participate in any of these events, please contact are new to the system. Healthcare Partners in Maryland Caitlin Sweeney, Assistant Director of Development and as the assistant facilities Alumnae/i Affairs, at [email protected]. administrator over dialysis units in eight hospitals across We are also very excited to announce that our group has the state. I have also enrolled partnered with the YSN Alumnae/i office to develop a regional in a DNP program at George representative initiative. We are in the process of recruiting Washington University in alumnae/i across the country to volunteer to be listed on Washington, DC, focused on the YSN website as a person of contact for YSN students executive management. to inquire about relocation, career advice, and networking opportunities in particular regional areas. Please email Carolyn Perrotti, 2013 I work [email protected] if you are interested in participating as an FNP in the United States in this program. YSN regional events have provided alumnae/i Air Force and was promoted to across the country an opportunity to connect. Please consider Captain. I moved to Auburn, CA, working with the alumnae/i office to coordinate an event in the self-proclaimed endurance your area! sports capital of the world. I am delighted to be working alongside a dedicated group of Christopher Norman, 2014 I am YSN alumnae/i. We hope to continue to provide our alumnae/i practicing as a geriatric nurse with opportunities to engage with each other, YSN, and YSN practitioner with University students. As always, if you are interested in working with the Geriatricians, the Division of Alumnae/i Association, please be in touch. Geriatrics at Upstate Medical University, in Syracuse, NY. We provide comprehensive outpatient primary care and Serena Cherry Flaherty ’06 consultation for folks over the President, YSNAA age of 65, inpatient consultation

FALL 2015 YALE NURSING MATTERS 17 ALUMNA SPOTLIGHT Lucy Garbus ’88: Awareness and Education as Tools to Tackle Toxic Stress

Since we last The group targeting policy makers is “Establishing a good relationship with connected with investigating how leaders can impact toxic the family is crucial to addressing toxic Lucy Garbus in the stress on a higher level. Lastly, the family/ stress,” she explained. Many times the fall of 2014, she caregivers-targeted group is working on how mother or caregiver will be resistant to help has continued to to disseminate information on toxic stress the first three times it is offered, but will expand her efforts through a media blitz. accept it the fourth time. At this point, the in the prevention In addition to her work with the mother or caregiver may disclose information of, screening for, Resiliency in Action campaign, Garbus will not known before, allowing the health care and education on present a poster on toxic stress at the provider a greater opportunity to treat the toxic stress. American Academy of Pediatrics national problem at hand. “Having good continuity Garbus joined the Resiliency in Action conference this month. It is entitled “Toxic and a healthy relationship with the family is workgroup, a collective impact pilot project Stress Screening Is Important and Possible: key for this very issue,” stated Garbus. funded through the Massachusetts Depart- A Practical Approach.” ment of Public Health. It has involved more Garbus also works under part of a grant “ Establishing a good than 100 community leaders and parents funded by the Boston Department of Public in Springfield, Massachusetts, in cross- Health. The grant promotes addressing toxic relationship with the family organizational discussions to discover the stress in primary care settings through sources of adversity that affect the lives integrative behavioral health. This expansion is crucial to addressing toxic of Springfield’s youngest children, ages birth grant, aimed at clinicians who already provide stress.” Many times the to five years, and their parents or caregivers. behavioral health care in their clinic, allows Part of the project included community them to expand upon it. mother or caregiver will be forums to discuss how Springfield’s commu- In addition, Garbus continues to screen resistant to help the first nity leaders and parents can collaborate to patients and families for toxic stress at her support resilience in young children. From the practice in Springfield. She cannot emphasize three times it is offered, but forums, it was decided that the community enough the importance of early intervention will accept it the fourth time. needed to hear one consistent and culturally in treating toxic stress. Early intervention has sensitive message regarding toxic stress historically been focused on children under At this point, the mother and how to build resilience in children. three years old with developmental delay, but or caregiver may disclose The overall message will target specific as professionals in the field are beginning to audiences, including family/caregivers, see that the relationship between child and information not known community, and policy makers. caregiver is so critical for healthy develop- before, allowing the health Currently, there are three workgroups, ment, more states are allowing a positive each working on a project tailored toward a screen to be a sufficient reason for referral. care provider a greater particular target audience. The community- “Our early intervention program has been opportunity to treat the targeted group conducts group trainings wonderful for us and for our families,” stated aimed at raising awareness about toxic stress. Garbus. problem at hand.

Interested in learning more about toxic stress? See the article on page 6 in this magazine, “Exposure to Toxic Stress in Childhood Linked to Risky Behavior and Adult Disease.” Also, view the TED talk by Nadine Burke Harris, titled “How Childhood Trauma Affects Health Across a Lifetime,” here: https://www.ted.com/talks/nadine_burke_harris_how_childhood_ trauma_affects_health_across_a_lifetime/transcript?language=en .

18 YALE NURSING MATTERS VOLUME 16 NUMBER 1 STUDENT Q&A

Jessica Crowell ’17 Family Nurse Practitioner Specialty

From: Salvisa, Kentucky currently in an era of nursing shortages, and Education: MS in psychology with a minor in I think this is greatly affected by outdated Islamic studies from Vanderbilt University, assumptions and incorrect portrayal of nurses May 2014. Studied abroad for six months at in the media. I think there needs to be more the Hebrew University in Jerusalem. outreach and awareness of who we are and what we do.

What experience(s) do you credit for What three words describe nursing most influencing you to become a nurse? adequately to you? When I was 11, my parents left the dairy Advocacy, relationship, and endurance. farming business and my mom started her training to become an RN and eventually What do you most look forward to during an FNP. This was my first exposure to your educational career at YSN? health care. I watched her be a resource to I look forward to being trained alongside people and develop incredible relationships students who share my passions, but also with her patients. She cared for people have their own goals and visions of nursing. beyond physical healing. I want to learn from my peers—hear their Working with Ethiopian refugees in stories, experiences, motivations, and Israel, Tibetan refugees in Minnesota, and ambitions. The determination and motivation currently, Iraqi refugees in Connecticut, everyone has to make a difference in their I learned about many of the needs and own unique way are pieces of a larger Top: Crowell volunteered alongside some of the Ethiopian obstacles of various refugee populations; healthcare puzzle. Some of my greatest youth that she met with weekly as part of her internship the area that stood out to me the most with the Ethiopian National Project. Middle: Crowell learning and reflecting experiences come looks back on the moment captured in this photo fondly was health care. Health care is a need, but from being exposed to others who have saying, “It reminds me of the incredible friendliness and refugees face so many barriers to care, passions apart from my own; I love it. hospitality that most Middle Easterners have, but is such as language, transportation, cost, It makes me aware of, and care about, almost never seen in western media.” Bottom: Crowell and differences in cultural beliefs and sits overlooking part of Jerusalem outside the Hebrew other aspects of nursing that I may not University of Jerusalem, which is where she studied. expectations about healing. have thought about otherwise. I want I knew that if I wanted to serve these to be challenged by the opinions, beliefs, populations well, then I needed to be trained and ideas of YSN students because I value What is one lasting impact you wish to have in providing holistic care—healing of the the differences we bring as a cohort. on the world? mind, body, and soul. Nurses are trained to I want people to feel that there is someone care beyond the physical, as I saw so clearly What appealed to you most about YSN? who cares about them—that no one is alone in the way my mother interacted with her I am interested in tying refugee services or unloved. I want everyone to feel like they patients. I knew exactly how I needed to be into my future practice, so the global health are needed and have a purpose, and I want to trained to best serve the most underserved. concentration was a pull factor. YSN also enable them to become more than they had a unique and intriguing focus on ever thought they could be. I have a heart for What do you love about nursing? interdisciplinary training and collaboration the lost and broken, which motivates me to From the very beginning of this program, with the School of Medicine, the Yale Center find them and be a buffer for any amount of I was challenged in my ability to balance the for British Art, and Yale School of Music. emotional, physical, mental, or spiritual physical, mental, emotional, and social needs Having a liberal arts and humanities suffering that they are enduring. of patients. This is what I love about nursing. background, I appreciate the approach and Every step of the training is grounded in opportunity to process the material in a If you weren’t a nurse, what would you be? respecting the patient as a person with way that is familiar to me. I would be more directly involved in refugee individual values that are worthy of being services, with Arab populations either in heard and integrated into the plan of care. What are your goals this year? America or in the Middle East. Ideally I am often my greatest enemy, so I need it would involve helping them with the early What would you change about nursing? to find a better balance between staying stages of their transition to life in a new If I were to change anything about nursing, humble while not discouraging myself into country and/or developing new refugee I would work to increase and improve thinking I should be more than I am. service programs that offer adequate strategies of recruitment to the field. We are resources and smoother acculturation.

FALL 2015 YALE NURSING MATTERS 19 In Praise of Preceptors By Mary (Betsy) Groth, APRN Lecturer in Nursing and Clinical Coordinator

Last fall, the Yale School of Nursing Alumni Association (YSNAA) presented its first annual Preceptor of the Year Award to Carol Ann Wetmore ’94, MSN. For the past 20 years, Wetmore has been a preceptor for YSN’s Graduate Entry Prespecialty in Nursing (GEPN) program. The award recognized her for “long-standing dedication to YSN students… continued enthusiasm for her role as nurse, teacher, mentor, and role model…[and] her warmth and approachability demonstrated to students, staff, and young patients.”

It is said that the nurse preceptor acts as a facilitated,” stated Honan. “In the clinical After speaking with various GEPN bridge between the classroom and the real arena, that integration of students’ knowledge, preceptors, whose experience precepting world of patients and clinical settings (Raines, skills, and aptitudes is nurtured. We are students ranged from four to 18 years, it was 2012). In order to build that bridge, nurse blessed that we have GEPN preceptors that found that they felt confident about their role preceptors must embrace the roles of mentor, are committed to our students, many for in creating meaningful and positive learning student advocate, and role model. The decades.” The average tenure of current experiences for students. Each of them relationship between a preceptor and student GEPN preceptors is 10 years. expressed real pleasure at returning to the develops over time, and the importance of Honan points out that during the bedside. Many stated that every year, that relationship cannot be overstated. James GEPN program, it is important that students precepting reignites their passion for the and Chapman (2010) have found that nursing are precepted by a variety of clinicians so nursing profession. A peak experience for students in their first acute care clinical that they can experience different strengths, many is the “ah-ha!” moment that occurs placement based their decisions regarding personalities, and ways of providing care. for students. whether to discontinue or continue their At a minimum, students will work with seven As a preceptor myself, the experience nursing studies on three main factors, one of preceptors over 11 months in five specialties: of precepting can almost be described as which was their perception of their preceptor. medical/surgical nursing, psychiatric, exhilarating. Each new student makes me YSN’s GEPN preceptors have been pediatric, maternal/newborn, and community reflect on why I became a nurse, what I influencing new nursing students since the health nursing. do and do not know, and what is important inception of the GEPN program in 1974. Preceptors may guide you through to impart to each individual student about the Associate Professor Linda Honan, PhD, MSN, your first injection, instruct you on how to art and science of nursing. To see students CNS-BC, RN, was director of the program for communicate with a person who is hearing develop into knowledgeable, skilled, and nearly a decade and course coordinator for voices, show you how to massage a post­ compassionate nurses, to see them identify more than 25 years. Honan describes the partum mother’s fundus, or coach you on with “I am your nurse,” is definitely a peak typical GEPN preceptor as a seasoned expert how to select the right-sized blood pressure experience of mine. As one preceptor stated, who is committed to the education of first- cuff for a three-year-old and how to explain to “Of all my roles as a nurse, this is the most year students. that child that “this will give your arm a little central to who I am.” “It is through a unique teacher-student hug.” He or she may also be the one who relationship that our students’ progress is instills in you the confidence to perform a References physical examination on an infant born just James, A., & Chapman, Y. (2010). Precepting and minutes ago, who will acknowledge your grief patients—the power of two: Nursing students’ and fear when your patient is a 32-year-old experience experiences on their first acute clinical mother of two who is dying of cancer, who placement. Contemporary Nurse, 34(1), 34-47. will understand when your patient reminds Raines, D. (2012). Nurse preceptors’ views of you of your grandfather, or who models pro- precepting undergraduate nursing students. Nursing ­fessional behavior when others clearly do not. Education Perspectives, 33(2), 76-79.

“While at YSN, I’ve been fortunate to have many excellent preceptors that have mastered the unique balance of simultaneously supporting and challenging their students, and their commitment to our clinical education is invaluable.” — Rachel Vaivoda ’16

Carol Ann Wetmore ’94 (right) with Shirley Girouard ’77 “The role of preceptor is an extremely important one to me. It’s another opportunity to make (left) at the 2014 reunion banquet at the Graduate Club. a small contribution to the future of nursing.” — Mary Pierson ’88, MSN

20 YALE NURSING MATTERS VOLUME 16 NUMBER 1 The Henderson Society, a giving club named after Virginia Henderson, launched in 2013 to provide financial aid to the many Yale nurses now at the school. One hundred percent of gifts at this level have been immediately distributed to the annual fund for current use scholarships.

A gift to the ysn 2015–2016 annual fund between $1,000 and $2,499 will establish your annual membership in the Henderson Society. Your name will then be added to the Henderson plaque at the entrance to the Yale School of Nursing.*

*Your name will be inscribed unless you wish to make your gift anonymously.

For more information, please contact [email protected] or 203-737-2137. non-profit org. us postage 344 Winchester Avenue paid New Haven, CT 06511 new haven, ct permit no.526