Voice magazine, spring 2024

A SCIENTIFIC APPROACH TO

JAIL DIVERSION

from the dean

Dear friend,

Nursing impacts health. We adapt to the ever-evolving health care landscape. We pioneer innovative solutions. We advance science, education, and clinical practice to shape a healthier future for all.

At Boston College, our commitment to excellence in nursing remains strong, both here on campus and across the globe. The spring 2024 edition of Voice is testament to that with articles spotlighting the extraordinary clinical, scholarly, and policy contributions of our community.

You’ll read about our new partnership with the Massachusetts Department of Mental Health to support the establishment of a Center for Police Training in Crisis Intervention based here at Boston College. We tell the story of four CSON faculty members dedicated to improving diabetes care and prevention for underserved communities and patient groups. And we feature a behind-the-scenes look at CSON’s novel approach to clinical placement—one that best serves the needs of students and clinical partners at the same time.

These stories show the power of nursing to impact health. They speak to the transformative nature of our profession and nursing’s vital role in shaping a healthier future for all. I hope they inspire you to continue to choose nursing every day.

Sincerely,

katherine e. gregory Dean

dean

Katherine E. Gregory

editors

John Shakespear

Kathleen Sullivan

managing editor

Tracy Bienen

art director

Christine Hunt

contributors

Tracy Bienen

Steven Constantine

Tim Gower

Nathaniel Moore

John Shakespear

Corinne Steinbrenner

Kathleen Sullivan

photographers

Caitlin Cunningham

Peter Julian

Lee Pellegrini

Voice is published by the William F. Connell School of Nursing and the Boston College Office of University Communications.

Address letters and comments to: csonalum@bc.edu

Associate Director, Marketing and Communications

William F. Connell School of Nursing

Maloney Hall

140 Commonwealth Ave. Chestnut Hill, MA 02467

Baccalaureate and direct entry master’s degree programs have full approval by the Massachusetts Board of Registration in Nursing.

CCNE Accredited 2018–2028

Spring 2024

2 Partnership with St. John’s nursing school in Belize, Lee is inducted into International Nurse Researcher Hall of Fame, faculty host Design Hackathon, CSON junior awarded Martin Luther King, Jr. Scholarship Features

4 A scientific approach to jail diversion Assistant Professor Victor Petreca heads a new center to improve policing and promote mental health

8 Filling the gaps CSON researchers Cherlie Magny-Normilus, Tam Nguyen, Patricia Underwood, and Katherine Wentzell search for better, more targeted diabetes interventions

12 Bridges to the bedside Assistant Dean Dany Hilaire and her team create an individualized approach to clinical education achievements

16 Faculty publications Using machine learning to understand health disparities, storytelling interventions for young cancer survivors, and overuse of benzodiazepines in older European adults

17 Faculty presentations Nursing contributions to a resilient workforce and healthy communities, linking vaginitis and sexually transmitted infections, and improving tuberculosis care in South Africa

IMAGE CREDITS Cover illustration, Christine Hunt. Back cover, Caitlin Cunningham. Left, Caitlin Cunningham. Above, clockwise from top left, Caitlin Cunningham, Lee Pellegrini, Noun Project, Caitlin Cunningham

Community

Four nurses from Belize— Marcia Aldana-Lennen, Ingrid Asusenia Gomez, Brithney Ortega, and Areli Rodriguez were awarded CSON master’s degrees in May and will become the inaugural faculty members at St. John’s College nursing school in Belize. CSON and St. John’s partnered to launch the new school to address Belize’s nursing shortage.

In March, the Connell School welcomed more than 100 nurses from 11 major health care institutions and schools of nursing to campus for the Greater Boston Nursing Collaborative (GBNC) meeting (pictured below). Through GBNC, nurses work together on strategic initiatives designed to advance the science and practice of integrative nursing.

BC School of Social Work Professor Summer Sherburne Hawkins, a social epidemiologist whose research interests include health disparities among women and children, was appointed the inaugural associate director of the interdisciplinary Global Public Health and the Common Good undergraduate program, which is housed in the Connell School.

In March, CSON and BC’s School of Social Work hosted Empowering Wellness: A Journey through Mental and Physical Health in Black and Brown Communities, a three-day event at Robsham Theater.

Research

Two teams were awarded CSON Innovation Grants, which fund small research projects essential to supporting large external research grant applications:

• Assistant Professor Eunji Cho and colleagues, including Assistant Professor Lindsey Camp, faculty from BC’s School of Social Work, and clinicians from Dana-Farber Cancer Institute and Boston Children’s Hospital, for their project “Promoting Human Flourishing: A Photovoice Study on the Optimal Health Care Model for Adolescents and Young Adults with Cancer.”

• Assistant Professor Melissa Uveges and her team, which includes Professor Karen Lyons, for their project “Understanding Family Management of Pediatric Heterozygous Familial Hypercholesterolemia.”

Christopher Lee , the Barry Family/Goldman Sachs Professor, is one of 30 world-renowned nurse scientists to be inducted into the Sigma Theta Tau International Honor Society of Nursing International Nurse Researcher Hall of Fame in July.

Lee and six Ph.D. students, Nickie Burney; David Geyer, M.S. ’19; Amy Goh; Katherine Ladetto ’96, M.S. ’02; Jacqueline Massaro; and Danielle Walker, M.S. ’16, presented at the Dublin-Boston Ph.D. Research Blitz. This forum is a collaboration with Trinity College Dublin’s School of Nursing & Midwifery where Ph.D. students can discuss their research. Boston College and Trinity College signed a Memorandum of Understanding establishing a formal partnership in December.

Assistant Professor Cherlie Magny-Normilus received an Academic Nursing Early Career Scholarship Award from the Massachusetts Association of Colleges of Nursing. She was recognized for her research on cardiometabolic disease experienced by vulnerable immigrant populations and her efforts to promote advanced nursing education levels in Haiti.

Events

Adelene Egan ’18 received the 15th annual Dean Rita P. Kelleher Award in April. She works as a senior staff nurse in neonatal intensive care at New York-Presbyterian/Weill Cornell Medical Center.

Denetra Hampton, (pictured right) a 22-year Navy veteran, former United States Naval Nurse Corps Officer, and founder of For Nurses By Nurses Productions, presented CSON’s spring Pinnacle lecture, “Advancing the Health Sciences through Scientific Storytelling.” Prior to the lecture, Hampton’s film “The Black Angels: A Nurse’s Story” was screened.

Faculty

Professor Ann Burgess was profiled in Psychology Today in March.

Assistant Professor Lindsey Camp’s discussion on the history of public health aired on C-SPAN2’s Lectures in History series in February.

Associate Professor of the Practice

Donna Cullinan, Assistant Professor of the Practice

Raymond Gasser, and Associate Professor and Strakosch Family Fellow Tam Nguyen developed the inaugural Design Hackathon as part of the population health clinical. In teams, CSON students learned design methods, discussed the impact of ChatGPT on the future of health decision-making, and used AI to generate personas for diabetes patients.

Professor Karen Lyons’s research on how supporting both patients and their care partners can lead to better healthcare outcomes was featured in Boston College Magazine

Assistant Professor Brittney van de Water joined the editorial board of BMC Global and Public Health —the first nurse to do so.

Shelley White, CSON’s director of experiential learning in the public health program, presented the art installation Landscapes and Lives Partitioned: Witnessing the Borderlands, an exhibition on militarization at the U.S./Mexico border, at Bentley University’s RSM Gallery in January.

Students and alumni

Julie Canuto-Depina ’25 (pictured right) was awarded Boston College’s 2024 Martin Luther King, Jr. Scholarship, an honor for which Esther Udoakang ’25 was also a finalist. The scholarship recognizes a BC junior who demonstrates superior academic achievement, extracurricular leadership, community service, and involvement with the African American community and issues.

Pediatric nurse practitioner Amy Delaney, Ph.D. ’24, was interviewed on WCVB-TV News for a story on the rise of seasonal respiratory illnesses in Massachusetts.

Ph.D. student Jordan Keels co-authored an international collaboration, “Current State of Genomics in Nursing: A Scoping Review of Healthcare Provider Oriented (Clinical and Educational) Outcomes (2012–2022),” in Genes

Ji In Kim, D.N.P. ’25, was a Boston College delegate to COP28, the world’s largest international climate change conference, which took place in December. The delegation briefed the BC community on their experience in two interactive sessions held online from Dubai, the location for COP28.

D.N.P. students Shalini Patel and Kalee Kite, along with their organizational sponsor from CSON partnering organization North Hill Independent Living, presented “Reducing Falls at Home in Healthy Older Adults” at the LeadingAge Conference in Chicago.

D.N.P. student Cheryl Slater was appointed to the Perinatal Neonatal Quality Improvement Network (PNQIN) Massachusetts board as its first neonatal nurse chair.

In memory

Marie Eppinger, who worked in the School of Nursing administration, died at the age of 93 on March 9, 2023.

Catherine Murphy, a former acting dean (1990–91), graduate nursing program director, and associate professor, died on December 30, 2023.

Mary Anne Seidel ’64, a former faculty member, died on May 22, 2023, in Brunswick, Maine.

JAIL DIVERSION A SCIENTIFIC APPROACH TO

Assistant Professor Victor Petreca heads a new center to improve policing and promote mental health

by n athaniel m oore, photograph by l ee pellegrini, illustrations by c hristine hunt

Every day, police departments nationwide are called to respond to an astonishing array of situations: crimes, behavioral health crises, lost adults suffering from dementia, and so many others. When the officers arrive, often with no forewarning about what they will find at the scene, they must assess the situation—Are substances involved? Are weapons present? What is the state of each person’s mental health?—and respond accordingly. It falls to the officers to size up what’s going on and address the situation while also working to protect people’s freedom and safety. So much depends on the snap judgments of police officers.

To help prevent potential tragedies when police encounter people in mental health crisis, a Center for Police Training in Crisis Intervention will be based at Boston College’s Connell School of Nursing (CSON). The center will serve as a beacon in the Commonwealth to promote community involvement in policing, research different ways first responders can engage people with behavioral health issues, and promote the adoption of emerging best practices.

The center’s new director and primary investigator is Victor Petreca, an assistant professor at CSON and expert in forensic psychiatry/mental health and nursing with a focus on jail diversion programs, which are designed to offer an alternative to incarceration that may achieve better results for both offenders with behavioral health challenges and the communities in which they live.

“The goal of my research at the center is to develop the knowledge required to help shape an evidencebased practice,” Petreca said. “Though jail diversion programs exist in other states and countries, the evidence about what works is actually very limited, so we need to do more studies in order to develop new and effective methodologies. First and foremost, we want everyone to be safe and to feel safe.”

The Context

From the start, it has been important to Petreca to precisely clarify the center’s aims.

“A successful jail diversion program is not one that diverts everyone involved in each incident away from jail,” he emphasized. “Some people are more appropriate for the correctional system than the health care system.”

Petreca stressed the importance of the traditional legal system because of the prevalence of two

common misconceptions, which he is at great pains to correct. First, he explained, having a mental illness does not absolve someone of responsibility for the crimes he or she commits. “You may have a domestic violence situation in which the aggressor is in fact suffering from mental illness,” he said. “All the same, incarceration may still be the best outcome for all involved.”

The second crucial misconception involves the perpetrators of the most serious crimes. “With the worst crimes we see,” Petreca explained, “mental illness is actually quite rare. Often, people who do atrocious things do not have serious mental health issues, but we probably think that they do as a way to ‘other’ the perpetrators of the crimes we find most appalling. These labels and stigmas affect how we see mental illness and criminal behavior and conflate the two in unproductive ways.”

In spite of these misconceptions, however, Petreca is very firm on the crucial truth that informs the

“If the root health concerns aren’t addressed, the police may be forced to respond to calls again and again… Instead, we must ask: What steps can be taken to get the person out of the revolving door with the legal system?”

center’s work: Forcing persons with serious mental illness through the legal system isn’t good for the person involved, the community, the police, or even, ultimately, the health care system.

“If a person suffers from schizophrenia and is arrested for trespassing, nobody’s interests are served,” he said. “If the root health concerns aren’t addressed, the police may be forced to respond to calls again and again, and the person involved may not get the care they need until they show up at an emergency room. This scenario is more dangerous and more costly than an effective jail diversion program. Instead, we must ask: What steps can be taken to get the person out of the revolving door with the legal system?”

The Research

In his work at the center, Petreca is using what’s known as a sequential-intercept model, which assesses the stage (or intercept) in the legal and health care systems where a person gets the mental health care he or she needs. At intercept zero, a person may reach out to a crisis line and get help without any interaction with the police at all. At intercept one, a person may interact with the police but be diverted away from the legal system. And at intercept two, a person may be legally directed into a substance treatment program and emerge, even if their treatment is successful, with a criminal record. Unfortunately, it’s not easy to know why some diversions produce good outcomes and others don’t.

The challenge, Petreca said, is determining “what variables predict a successful diversion. It’s not just that there are so many factors to consider, there are also so many different ethics that we value: beneficence, justice, autonomy. Because of all these competing values and variables, it’s not always easy to measure success.”

Petreca and his diverse team of analysts and researchers are looking to determine how many people can be safely diverted at intercept one. To that end, he and his team are considering dozens of variables to determine how they correlate with different outcomes. These include time of day; sex, race, ethnicity, and other demographic markers; whether a chargeable offense has been committed; and the presence of a clinician on the response team, among many others.

Because this problem is so complex and the interactions of different variables are so difficult to evaluate simultaneously, Petreca will leverage the power of emerging AI technology to consider as many variables as possible. “AI can run endless scenarios to test different combinations of approaches. Some variables make a big difference and some turn out to make no difference at all. The more we know, the more the program will succeed.”

The ultimate goal is to develop a decision tree that first responders can rely on in a behavioral crisis incident: if drugs are present, for instance, the first responders would take this action; if drugs are absent, they may do the opposite. “The hope is that the tree will help responders safely make nuanced judgment calls that necessarily involve so much complexity and subjectivity,” Petreca said.

The Impact

Petreca and his team expect the decision tree to help the center fulfill the second part of its mandate: training police officers to effectively respond to behavioral crises. By law, no less than half of patrol officers in every Massachusetts municipality must now have this training, and no less than a quarter of their overseers must have it as well. In a state with 167 different municipal police forces, this requirement entails a massive undertaking for the center and its partner training organizations.

Fortunately, Petreca has encountered a series of police forces not just willing but eager to adopt the tools the center provides. “Police departments recognize their community’s needs and have been not only welcoming but excited for the resources and support,” he said. “Law enforcement stepped up to meet community needs by teaming up with experts to better handle behavioral crises, showing a strong commitment for better solutions.”

William Evans, BC’s executive director of public safety, chief of police, and the former Boston Police Commissioner, echoed Petreca. “Police officers recognize the value in having agencies like this to help them,”

The center team comprises:

• Director/primary investigator

• Research assistants

• Program manager who is a licensed social worker

• Data analyst

• Implementation specialist

• Consultants/trainers

• Nurses/mental health clinicians

• Undergraduate research fellows

The Center for Police Training in Crisis Intervention:

• promotes community involvement in policing

• examines how first responders can engage people with behavioral health issues

• ensures the adoption of emerging best practices

he said. “Most police departments have known for a long time that mental health is a serious concern, but they just didn’t always have the tools to engage a behavioral crisis effectively.

“That’s why I love Victor’s focus: he isn’t there to criticize anybody, but to make the relationship between the police and the medical profession better,” Evans said. “I give him a lot of credit for stepping up and taking a leading role.”

Not only does this enthusiastic and public engagement from police forces make it easier for the center to effectively conduct its training, it may help promote community involvement in ways that help prevent people from reaching intercept two. “Many people dealing with a behavioral crisis fear the police,” Petreca said. “Perhaps if they knew and understood that there’s a jail diversion program, they would be less hesitant to call and get help.”

At this early stage, Petreca can’t say—and won’t predict— which variables will turn out to be most important for the success of jail diversion programs. He did, however, recently publish a study in the Journal of Advanced Nursing —“The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing”—calling for the inclusion of nurses in multidisciplinary first-responder teams. “Because nurses can do physical exams and many of them have mental health training, I’d like to see if they can help produce better outcomes,” he said.

Whichever interventions prove to be most effective, Petreca sees them as building on the good work already being done. “I hope the broader BC community realizes how deeply police officers are driven by care for the community,” he said. “It’s just remarkable how much effort they put into being better at their jobs.” ▪

The Massachusetts Department of Mental Health is supporting the establishment of the Center for Police Training in Crisis Intervention.

f i lling t h e gaps

CSON researchers search for better, more targeted diabetes interventions

by tim gower

p hotographs by lee pellegrini, caitlin cunningham, p eter julian

Diabetes can be a devastating disease if not carefully managed, as suboptimal control of blood glucose (or blood sugar) levels can increase the risk for cardiovascular disease, kidney damage, vision loss, and other grave conditions. Overall, 11.6 percent of people in the United States have diabetes according to the American Diabetes Association, though rates are highest within certain populations, including Black, Hispanic, Asian American, and American Indian adults.

Four faculty members at the Connell School of Nursing (CSON) are searching for ways to fill gaps in the care of diabetes that affect underserved communities and other patient groups that often struggle to receive adequate treatment and preventive measures. These researchers are driven to improve diabetes care as part of their commitment to Boston College’s mission of living in service to others.

embracing tech to control diabetes

One important lesson of the COVID-19 pandemic was that diabetes is a condition that is amenable to virtual medicine. “It really changed the landscape of how we were able to deliver care,” says Assistant Professor

patricia underwood, who is also an endocrine nurse practitioner at the VA Boston Healthcare System (VA). When physical distancing became necessary, Underwood and her colleagues at the VA pivoted and were soon conducting 12–14 virtual appointments a day through teleconferencing or phone calls.

They made that possible by training patients to use technology called continuous glucose monitoring (CGM), which consists of a wearable device that tracks blood glucose levels in real time and transmits that information to a smartphone or receiver. Importantly, CGM data can be uploaded to a website that a clinician can view to determine whether a patient’s treatment plan is maintaining healthy blood glucose levels.

“We were able to deliver care to patients who otherwise wouldn’t have received it,” says Underwood. She was lead author of a 2022 paper that described several patients in her clinic who successfully overcame obstacles to controlling blood sugar with CGM and virtual visits, and how to integrate this technology into practice, published in the Journal of the American Association of Nurse Practitioners

In other work, Underwood recently used an experimental metric developed by her colleagues at the VA called A1C time-in-range (TIR) to show that diabetes patients whose blood glucose frequently rises too high or drops too low have an increased risk for dementia. “People don’t think of dementia as a complication of diabetes, but it is,” says endocrinologist Paul Conlin, MD, chief of medicine at VA Boston (and BC Class of ’79), who heads the team that developed the A1C TIR. Next up, Underwood, who has worked alongside Conlin as a clinical scientist since 2022, plans to examine how patient lifestyle behavior, medication, and provider practices affect A1C TIR.

“If we can understand predictors of this metric,” says Underwood, “it would help us to design better clinical interventions.”

coping with health disparities in diabetes

Assistant Professor cherlie magny-normilus is seeking to improve self-management of type 2 diabetes (T2D, which occurs when cells resist the hormone insulin) among Haitian immigrants in the United States, who experience higher rates of complications from the disease than other comparable ethnic groups. With support from the National Institute for Nursing Research, Magny-Normilus has developed a multilevel, culturally tailored intervention program that educates Haitian adults with T2D about the roles of diet, physical activity, and medication in managing the disease, which she is currently pilot testing.

Magny-Normilus used a variety of resources to design the six-part program, including a preliminary study of 81 Haitians with T2D, who described their management behaviors and barriers to effective blood sugar control. Participants also wore CGMs and actigraphy devices for 14 days to provide data about their blood glucose variability and level of physical activity.

In that preliminary phase, Magny-Normilus discovered that participants were able to see from their CGM’s graphics how eating a high-carbohydrate meal caused blood sugar to soar, helping them understand the importance of diet modification. “No wonder my A1C continues to be high,” one participant said. Meanwhile, she also discovered that many study participants said they didn’t feel safe exercising outdoors in their neighborhoods and couldn’t afford gym memberships. “So I’m trying to embed instructions about ways to get physical activity even at home by moving around more into the intervention,” says Magny-Normilus.

Importantly, Magny-Normilus learned that housing issues, lack of access to healthy foods, and racial discrimination act as barriers to diabetes management, but many study participants were reluctant to seek help with these problems. “This is a population that is very prideful,” says Magny-Normilus, a variable she accounts for in her interventions by guiding participants in need of social-support services to agencies and organizations where they will feel comfortable and their language and culture are understood. After completing this pilot study next year, Magny-Normilus plans to evaluate it in a multi-site clinical trial.

cultural adaptation for preventing diabetes

Rates of T2D are rising faster among Asian Americans than other racial groups in the United States. The landmark Diabetes Prevention Program (DPP) study found that lifestyle changes can reduce the risk for developing T2D, but Associate Professor tam nguyen says the implementation of this program among Asian American patients often ignores cultural and physiological realities that render it less likely to be effective. For example, the DPP demonstrated that losing 5 to 7 percent of body weight can help prevent the onset of T2D. “But a lot of Asians just don’t have a lot of weight to lose,” says Nguyen.

However, some Asian Americans who are not overweight nonetheless have significant abdominal fat, which is linked to T2D, suggesting that a custom approach may be

beneficial. “For Asians, we think that exercise is more important than weight loss,” says Nguyen, who plans to work with an exercise physiologist to test different types of aerobic and strength regimens that target abdominal fat, and see if they reduce diabetes risk.

Other cultural adaptations Nguyen says are necessary include dietary recommendations for reducing T2D risk: advice to cut back on cheeseburgers and donuts won’t mean much to a Vietnamese American whose favorite foods are spring rolls and pho, for example. Nguyen has launched a pilot project to adapt the DPP for the Vietnamese community, and—thanks to a $5.5 million grant from the Centers for Disease Control and Prevention—her team will expand this initiative to include people of Chinese and Asian Indian descent, too, in collaboration with Quincy Asian Resources, the Joslin Diabetes Center, and South Cove Community Health Center.

targeting “diabetes distress”

Living with type 1 diabetes (T1D, caused by a loss of insulin-producing pancreas cells) is often compared to having a full-time job, given the frequent need to administer insulin, monitor blood glucose levels, and take other steps to maintain stable blood sugar. That’s emotionally challenging for any patient, but emerging adults with T1D face unusually high levels of “diabetes distress,” says Katherine wentzell , a pediatric nurse practitioner at the Joslin Diabetes Center who returns to Boston College this summer as an assistant professor. Wentzell’s research focuses on understanding diabetes distress in emerging adults (aged 18 to 30) and finding ways to overcome it.

“No one does diabetes on their own,” says Wentzell, but emerging adults have likely left their parents’ home to attend college or live independently, so they often lack a support team. Competing demands of higher education, work, and new social and romantic relationships can distract from diabetes management, resulting in out-of-range blood glucose. “That can lead to anger, frustration, and feeling overwhelmed,” says Wentzell, which can further interfere with completing the many daily tasks of diabetes. “And you just continue in this cycle that’s really hard to get out of.”

To better understand the experience of diabetes distress in this patient population, Wentzell developed the Problem Areas in Diabetes-Emerging Adult (PAID-EA) survey, the first of its kind, which is now being used in multiple studies and will be translated into several languages. Wentzell’s survey has revealed that about nine out of 10 emerging adults with T1D worry about the cost of diabetes, and some reports suggest that the rising price of insulin has led 30 to 50 percent of young adults to ration the drug, she says. Wentzell now hopes to launch a study of how cost worries in these patients affect their diabetes-management behaviors, and how the choices they make— such as putting off refilling an insulin prescription— influence their outcomes. ▪

diabetes in the united states by the numbers

38.4 M have diabetes (as of 2021)

97.6 M

have prediabetes, a condition characterized by higher-than-normal blood glucose that can progress to type 2 diabetes

1.2 M are diagnosed with diabetes each year

Source: American Diabetes Association

AN INDIVIDUALIZED APPROACH TO CLINICAL EDUCATION

by john sha K espear

hotographs by caitlin cunningham

It’s no secret that the Boston area is a global hub for health care, home to some of the world’s best hospitals, community health centers, and public health agencies. At the Connell School of Nursing (CSON), this wealth of opportunity provides fertile ground for one of the nation’s most robust and innovative clinical education programs.

Through the work of CSON’s dedicated team of clinical placement specialists and faculty program directors, every undergraduate and graduate student is paired with the right hands-on clinical placements and preceptors for their career goals and licensure needs. These clinical experiences form the backbone of a robust nursing education— the vital intersection where classroom learning becomes patient care and research meets practice.

“Clinical education is the foundation of nursing education because it bridges the gap between what students learn in the classroom and care at the bedside. I have seen how impactful it is when a school is invested in clinical education; when BC students are ready to enter the workforce, they are truly prepared.”

dany hilaire, ph. d., assistant dean oF clinical placement and community partnerships

p

UNCOMMON SUPPORT

As the Connell School’s assistant dean of clinical placement and community partnerships, Dany Hilaire, Ph.D., leads a dedicated team of placement specialists who work to create and maintain relationships with preceptors and health care organizations around the region, many of whom have mentored Boston College students for years. Hilaire and her colleagues work closely with CSON’s faculty program directors to match each undergraduate and graduate student with the placements they need. This is a crucial process, and not a simple one—every placement must meet licensure requirements, and every student must complete a specific set of clinical hours to pass the National Council Licensure Examination (NCLEX) or their nurse practitioner board certification.

“We meet with the program directors weekly to make sure we’re facilitating the right placements for each student,” Hilaire said. “We take their preferences into consideration, but we also think about which placements would be a good fit for them and what they need to sit for their exams and graduate on time.”

750 total clinical hours for D.N.P. Students ~720

4 dedicated clinical placement staff clinical education by the numbers

total clinical hours for undergraduate/ prelicensure students

~400

CSON students involved in clinical placements each semester

85+ clinical partners across the Boston area

At the undergraduate level, many schools of nursing do the hard work of finding preceptors and clinical placements for their students, but the Connell School is among a select group of nursing schools with the resources and bandwidth to find placements for graduate students as well. Hilaire and her team also secure placements for future nurse practitioners in the Doctor of Nursing Practice program and students in the Advanced Generalist Master of Science in Nursing program, including those on the direct-entry track, who are new to the field of nursing and might find it difficult to navigate the nuances of finding their own clinical placement.

“It’s a great benefit that we’re able to facilitate these placements for students,” Hilaire said. “We do it well, and it relieves the stress on students to find their own preceptor amid everything else they have to do.”

WIDE-RANGING EXPERIENCES

Connell School students complete clinical rotations in three different kinds of settings—at hospitals, community health agencies, and providers that care for specialized populations, like the VA Boston Healthcare System, the renowned Boston Health Care for the Homeless Program, and McLean Hospital, which U.S. News & World Report ranks number two in the nation in psychiatry.

Through these diverse opportunities, undergraduate and master’s students gain a sense of where they might like to work after graduation, and D.N.P. students build specialized expertise in the area they plan to practice in as nurse practitioners.

“As a Black, Haitian American provider, my patients and my preceptor look like me and share my culture and language. In a field that lacks diversity and where many birthing people of color are failed by their providers during and after childbirth, I can communicate, relate to, and understand my patients, and—most importantly—escalate their health care needs alongside my preceptor.”

sarah d ominique, d.n.p. ’25 clinical placements: c ambridge health alliance and mattapan community health center

“The preceptors are spectacular. They’ve provided unwavering guidance, support, and mentorship. They’re role models for the empathy and advocacy I aspire to embody as a future nurse practitioner.”

christina maria o’connor gonzález- rubio, d.n.p. ’25 clinical placements: Family health center oF worcester and middlesex school

THE SIMULATION LAB

In CSON’s state-of-the-science Simulation Lab, students begin preparing to practice before they ever set foot in a clinical setting. Housed within Maloney Hall, the Simulation Lab’s realistic and fully equipped exam rooms and surgical suite offer a risk-free, faculty-observed space where students practice skills ranging from patient diagnosis to preterm infant delivery on responsive computerized manikins. Graduate students also perform simulations with live patient actors, honing advanced clinical skills like differential diagnosis.

“In my past roles, I have noticed how much more prepared BC students are in the clinical setting,” said Hilaire, who was previously the director of research and academic affiliations at Brigham and Women’s Hospital. “I think it’s because of the work that we do here to prepare them and the collaboration that the faculty have with the lab and our clinical partners.” ▪

2,000 square feet of learning space in the Brown Family Learning Laboratory

4 simulation rooms that resemble a pediatric exam room, adult hospital room, maternity room, and surgical suite

5 primary care exam rooms where simulations involving live actors take place

publications & presentations

Summaries of notable articles and talks

by c orinne s teinbrenner

Using Machine Learning to Understand Health Disparities

Health inequalities are a persistent problem in the United States. Associate Dean for Research and Integrated Science Diana Bowser is hopeful that machine learning will help researchers better understand what drives that inequality. For a study recently published in Health Affairs Scholar, Bowser and research associates including Kaili Maurico and Brielle Ruscitti applied a machine-learning algorithm to vast amounts of county-level data from the Agency for Healthcare Research and Quality’s Social Determinants of Health Database. The algorithm searched for similarities in the data and then grouped the most similar counties together into clusters. The exercise resulted in three distinct clusters: poor rural counties with low levels of life expectancy; suburban counties with higher life expectancy; and urban counties with low poverty, high education, and above-average life expectancy. When applied to a color-coded map, the pattern of data clusters surprised Bowser: “Cluster One counties, with the lowest life expectancy, are not located in just one region of the U.S.—they are dispersed all over,” she says. “There are counties in Texas that behave very similarly to one in Maine.” What’s not surprising, she says, is that health care infrastructure and access were the primary drivers of which counties fell in which cluster.

Fine-tuning a Storytelling Intervention for Young Cancer Survivors

A former pediatric oncology nurse, Assistant Professor Eunji Cho is developing and testing various storytelling interventions to promote human flourishing—a multidimensional process of growth and maturity—among young patients with life-threatening conditions. Cho proposed an intervention for adolescent and young adult (AYA) cancer survivors that involves the survivors and their oncology nurses sharing personal stories with one another. In a recent qualitative study, Cho and colleagues at Vanderbilt University surveyed a dozen AYA cancer survivors, asking for

feedback on the proposed intervention. While AYA participants expressed strong interest in storytelling activities in general, they had mixed opinions about sharing stories with their nurses. Some felt nurses would be appropriate storytelling partners, while others said they’d be more comfortable working on stories alone or with another cancer survivor. Survey participants also had mixed opinions about the intervention format (in-person or online) and timing (during or after cancer treatment). “Their mixed responses may indicate that the intervention requires a flexible, individualized format to fulfill their needs and acknowledge their different preferences,” Cho writes. Details of her study appear in the March 2024 issue of the Journal of Holistic Nursing

Overuse of Benzodiazepines in Older European Adults

Benzodiazepines (BZDs) are often prescribed to treat anxiety and insomnia, but their negative effects can include falls, fractures, cognitive decline, and delirium. It’s for these reasons, according to Professor Elizabeth Howard, that many health care providers in the United States try to avoid or reduce the duration of prescribing BZDs to older adults. Howard recently coauthored a study published in BMC Geriatrics that examined the use of BZDs in older adults in seven European countries (the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain) and found alarmingly high rates of BZD usage. For the study, patients 65 and older who lived in the community (rather than in a care facility) and visited a participating pharmacy between February 2019 and March 2020 answered questions about their health and medications. Nearly 15% reported taking at least one BZD, with highest prevalence in Croatia (35.5%), Spain (33.5%), and Serbia (31.3%). Among BZD users, 71% used the medications for more than a year, and 36% used them for more than five years. Additionally, users’ prescriptions frequently exceeded the recommended dosage for older populations.

Nurses Contributing to a Resilient Workforce and Healthy Communities

Professor Susan Gennaro spoke at an invitation-only conference in Sicily organized by FNOPI-CERSI, an Italian center for excellence aimed at promoting and developing nursing research in Italy, Europe, and around the world. The conference focused on global strategies for creating equitable and resilient health care. As a participant in a roundtable discussion, Gennaro emphasized the importance of a healthy workforce, with nurses taking care of their own health and finding ways to bring joy into their workplaces. According to Gennaro, the nursing profession can work with communities to ensure members have access to services and facilities—including housing, transportation, health care facilities, community spaces, and programming—that are accessible to people of all ages and support healthy lifestyle choices.

The Link between Vaginitis and Sexually Transmitted Infections

Sexually transmitted infections (STIs) are steadily climbing in the United States, with cases of syphilis up 80% in the last five years, according to data from the Centers for Disease Control and Prevention. STI rates are particularly high among people with vaginas and in people under 25. To help address this public health crisis, Instructor Alison Marshall recently recorded a podcast for Nurse Practitioners Associates for Continuing Education titled “Vaginitis and STIs: The Itch to Know More.” In the podcast, Marshall discusses factors that are contributing to the increase in STIs, including decreased condom usage and high rates of bacterial vaginosis (BV). Research shows that having BV increases the risk of acquiring an STI. Research also shows that using vulvar and intervaginal hygiene products disrupts the vaginal microbiome, thereby increasing the risk of developing BV. While many people turn to vaginal cleansers, deodorizers, and hair removal products to improve their vaginal health, it’s in fact the increased use of these products, according to Marshall, that is causing harm and contributing to the rise of STIs.

Improving Tuberculosis Care in South Africa

In April, Assistant Professor Brittney van de Water and colleagues presented two posters at the International Union Against Tuberculosis (TB) and Lung Disease’s 2024 TB Conference in Baltimore, related to her recent study aimed at improving TB care in a low-resource area of South Africa. For the study, van de Water and colleagues worked with four local clinics to screen household contacts (HHCs) of patients diagnosed with TB. By making home visits (which sometimes involved up to an hour of walking), the clinicians were able to screen 71% of the nearly 1,700 identified HHCs, a substantial improvement from her prior findings in the same area. However, of the 789 HHCs determined to be eligible for TB preventive therapy (TPT), only 11% initiated the therapy, which required them to visit a clinic. Most (61%) of the HHCs who initiated TPT went on to complete the therapy. Van de Water is now working on a larger study that emphasizes clinic-based, rather than home-based, TB interventions. “I don’t think it’s an either/or situation,” she says. “We need to do outreach to people’s homes, and we need to improve what’s happening at the clinics as well.”

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Why do you choose nursing?

As nurses, we meet our profession’s challenges and stand together to pursue a healthier and more compassionate world. Earlier this year, CSON reached out to academic and clinical nurses across the country to ask why they chose nursing. View their responses and let us know what inspires you.