The importance of truly belonging

by k athleen s ullivan

The struggle for equity was something Leah Gordon recognized as a young child, well before anything was called diversity, equity, and inclusion, or DEI. It was core to her father’s work as commandant of the Soldiers’ Home in Chelsea, Massachusetts.

“Making sure veterans got their fair and equitable share of good health care and access was so important to him,” said Gordon, an Afro-Latina whose mother immigrated from Panama.

“Seeing his commitment to veterans resonated with my family and our world as people of color.”

Gordon joined the Connell School of Nursing in January as associate dean for inclusive excellence, diversity, and belonging after serving as director of diversity for Mass General Hospital’s Nursing and Patient Care Services Department. As associate dean, Gordon provides leadership and vision for CSON’s diversity and inclusion efforts. She is a central resource and advocate for CSON students, faculty, and staff, and leads the Diversity in Nursing and Action Committee (previously known as the Diversity Advisory Board). She is also developing training programs, events, and activities geared toward the entire CSON community.

Gordon sees a sense of belonging as a crucial first step in diversity efforts. “We need to create an environment that makes people feel like they belong—where their identities are acknowledged and they can be their authentic selves. It’s essential groundwork for building and maintaining a diverse faculty and student body,” said Gordon.

One of her priorities is to deepen CSON’s connections with community partners, who bring a “highly developed understanding of the communities and patients we serve and help us bridge the gaps caused by social determinants of health.” She also launched a monthly healing circle where “the CSON community comes together to hold an open conversation about outside events that are affecting them in an atmosphere of respect and concern.” Participants offer and receive support and listen without question or judgment.

Gordon said that CSON Dean Katherine Gregory’s support has been invaluable. “In DEI work, if you don’t have leadership support, it’s very difficult for these initiatives to thrive,” she said. “I came to BC because I saw the level of support around the idea of creating community and a commitment to DEI work.”

Gordon is also an associate professor of the practice who is currently co-teaching Advanced Health Assessment to CSON graduate students who are preparing to be advanced practice clinicians. For nearly 20 years, the focus of her clinical practice has been caring for oncology patients, and she continues to work one day a week as a radiation and oncology nurse practitioner at MGH.

Because nurses lead with empathy, Gordon sees them as natural leaders in making health care more equitable and just. She wants Connell to be a place where the seeds of equity are planted.

“We can offer the training, knowledge, and preparation to create stewards who will call out bias, racism, or any ‘ism’ or ‘phobia’ in health care settings, help address it, and provide a resolution to it.” ▪

Being seen and valued

Gordon knows how transformational a sense of belonging can be. Early in her career, she worked at Dana-Farber Cancer Institute in multiple support roles, engaging with patients and supporting nurses and physicians. During that time, she met nurse practitioner and CSON alumna Kim Noonan, M.S. ’88, who felt Gordon belonged in the nursing profession.

“What are you doing with your life?” Gordon recalls Noonan saying to her. “I see qualities in you to be a nurse.”

While nursing appealed to Gordon, the journey to earn a college degree and become a nurse practitioner seemed daunting. At the time, she was a single mother to a toddler and would need to work full time while going to school. After years of hard work, she graduated from Regis College with an M.S. in nursing around the same time her daughter graduated high school. In 2017, Gordon earned a D.N.P.

Gordon and Noonan have remained good friends since those early days at Dana-Farber.

“There have been lots of changes and struggles on this journey. The nursing profession saved my life. And it’s a profession that I absolutely love.

“All it takes sometimes is one person to just say, ‘I believe in you. Go do it.’”

Restarting International Trips After Pandemic Hiatus

In January, CSON faculty and students resumed their international immersion and educational trips for the first time since the start of the pandemic, traveling to the Dominican Republic, Belize, and Chile to connect with health promoters, meet and treat community members, and teach health.

“I thought you had forgotten us,” said Maria, a community member in Experimental, Dominican Republic, when she reunited with CSON faculty member Rosemary Byrne. The two women have known each other for years, having met during one of CSON’s regular visits, but it was the first time they had seen each other since 2020.

“It’s important to the community that we returned,” said Byrne. “It’s a note of support for them.”

These types of immersive experiences benefit both host communities and the BC students. The communities receive health care and training while BC students have opportunities to enhance their Spanish language skills, witness other traditions and cultures firsthand, and increase their awareness of global health issues and inequities.

Specifically, the CSON groups assisted Jesuit colleagues who are developing a nursing school in Belize; studied the differences between public and private health care settings in Chile; and cared for children, adults, and elders in Dominican Republic communities. Here’s what some of the CSON students had to say about their experiences:

Accounts of student experiences have been condensed and edited. Photographs courtesy of students and faculty.

BELIZE

“[In Chile] we saw firsthand how social policies can drive health. The government funds the public system, while more economically sound individuals pay into the private system.… Social determinants of health drive the differences between care in Chile. As in the United States, access to adequate care may decrease with a decrease in income.”

✭ CHILE TRIP PARTICIPANT ✭

Dominican Republic

“My biggest takeaway from the trip is that nursing care is so much more than taking vitals and administering medications. Taking the time to get to know each individual patient, their values, their family, and what they value is a privilege and blessing.”

DOMINICAN REPUBLIC TRIP PARTICIPANT ✭

Summaries of notable articles and talks

by c orinne s teinbrenner

publications

Arab and Arab American College Students at Risk for Depression and Anxiety

A team of researchers, including Associate Professor Nadia Abuelezam, recently analyzed data from the 2015–2018 Healthy Minds Survey to assess mental health risks among Arab and Arab American students at U.S. colleges. The survey, which is administered annually to a random sample of undergraduate and graduate students, measures mental health status and related factors and includes an extensive demographics section. The researchers’ analysis showed that, after adjusting for a variety of factors, students who identified as Middle Eastern/Arab/Arab American had 40 percent higher odds of reporting symptoms of depression and 41 percent higher odds of reporting symptoms of anxiety than did non-Arab white students. Further analysis showed that Arab students who reported religion was important in their lives had lower odds of depression and anxiety than did non-religious Arab students. Conversely, Arab students who reported having experienced some form of discrimination in the previous year had higher odds of depression and anxiety than did those who reported no incidents of discrimination. A paper detailing these findings, “Depression and Anxiety Symptoms among Arab/Middle Eastern American College Students: Modifying Religiosity and Discrimination,” was published in November in the journal PLOS ONE

An Ethics Textbook for Advanced Practice

Registered Nurses

Associate Professor Emerita Pamela Grace and Assistant Professor Melissa Uveges, both specialists in nursing ethics, have published an updated fourth edition of Grace’s textbook, Nursing Ethics and Professional Responsibility in Advanced Practice (Jones & Bartlett Learning, 2023), with contributions from numerous Connell School graduates and faculty members. According to the publisher, the book remains the only comprehensive textbook available on the ethical issues faced by advanced practice registered nurses providing frontline care. Its early chapters provide a foundation in ethics and its application to nursing. Later chapters address ethical issues in specific specialty areas, such as neonatal care, gender-re - lated care, mental health, and palliative care. The new edition—the latest update of the text since 2017—includes expanded information on social justice and new discussions of managing social media, electronic health records, and ethical issues specific to certified registered nurse anesthetists and clinical nurse specialists in surgical settings. Instructors who adopt the textbook have access to downloadable supplements, including lecture slides, discussion questions, and additional case studies. One reviewer suggested the book could be a valuable resource not just for educators but also for nurse leaders and mentors.

Understanding the Connections between Chronic Conditions and Mental Health in African Caribbeans

Caribbeans are disproportionately affected by chronic noncommunicable diseases (NCDs), such as diabetes and hypertension. Given that mental illness can make managing chronic diseases more difficult, a team of Connell School researchers recently conducted a review of published studies, looking to better understand the association between mental health and NCDs in the African Caribbean population. The researchers—Assistant Professor Cherlie Magny-Normilus, Barry Family/Goldman Sachs Endowed Chair in Nursing Christopher Lee , and Associate Professor Corrine Y. Jurgens —published their findings in the October 2022 issue of Biomedicines in a paper titled “Implications for Self-Management among African Caribbean Adults with Noncommunicable Diseases and Mental Health Disorders: A Systematic Review.” The researchers identified 14 quality studies completed between 2006 and 2021 that fit their research criteria. These studies showed a strong association between depression and chronic NCDs among African Caribbeans, especially among women. The studies identified many barriers to NCD self-management among African Caribbeans, including depressive symptoms, social isolation, lack of social support, lack or resources, and substance abuse. (While overall African Caribbeans had reduced substance use, those with severe mental illness had elevated substance use disorder.)

Family and general social support were found to improve selfmanagement for both NCDs and mental illness.

presentations

A Framework to Guide Genomic Health Care

Associate Professor and Interim Associate Dean for Graduate Programs Andrew Dwyer and an international team of colleagues presented a research poster, “ACCESS: A Practice-Guiding Framework for Overcoming Disparities in Genomic Healthcare,” at the 2022 International Society of Nurses in Genetics World Congress in November. The poster outlined the researchers’ proposal for a framework that bedside nurses can use to guide their interactions with patients with gene-related conditions, with the ultimate goal of allowing more people to access the benefits of genomic medicine. The framework is built around the acronym ACCESS. The A in ACCESS urges nurses to Advocate for patients and families to receive genetic testing and counseling. The Cs ask nurses to support active Coping so patients can then decide whether and how to Communicate their genetic information to family members. If patients do communicate genetic risks to family, the framework asks nurses to advocate for cascadE Screening of at-risk relatives. Finally, the framework reminds nurses of the importance of long-term Surveillance of patients. Dwyer and colleagues discussed their ACCESS framework again in April during a webinar organized by the Global Genomics Nursing Alliance.

Building Algorithms to Improve Care for Older Adults

Professor Elizabeth Howard is part of an international team of researchers working on the I-CARE4OLD project—a European Union-funded initiative to develop a digital platform that will help health care providers create well-informed care plans for older adults with chronic complex conditions. As part of this work, Howard and colleagues analyzed longitudinal data gathered between 2015 and 2018 in U.S. and Canadian nursing homes to identify predictors of cognitive decline in nursing home residents. They then used that analysis to create an algorithm to predict cognitive decline in patients in long-term care settings. (Further work by I-CARE4OLD collaborators will identify interventions that improve cognitive-decline trajectories, and that data will be added to the platform.) Howard presented her work on the algorithm at the annual meeting of interRAI’s Network for Integrated Care and Aging in Quebec City in October. She is a fellow of interRAI, an international network of researchers and practitioners committed to improving care for persons who are disabled or medically complex. The I-CARE4OLD project makes use of data that is routinely collected using instruments developed by interRAI.

Creating a Toolkit for Graduate-Level Nursing Programs

In 2021, the American Association of Colleges of Nursing (AACN) approved new standards for nursing education based on expected competencies for graduates of nursing programs. As a member of the American Psychiatric Nurses Association (APNA) Graduate Education Council, Associate Professor of the Practice Karen Pounds serves on a task force working to create a toolkit that will help graduate-level nursing programs align their mental health curricula with these competencies. Her task force’s portion of the toolkit will address competencies related to providing person-centered care. At APNA’s annual conference in October, Pounds and a colleague presented a poster summarizing the work they’ve completed on the toolkit thus far: “Patient-Centered Care: Development and Application of the New AACN Domain #2 in Graduate Psychiatric Mental Health Nursing Education.” The poster outlines the theories nursing classes should teach to address the expected competencies, clinical experiences students should have to learn the competencies, and ways to evaluate students’ mastery of the competencies. Pounds says she and colleagues on the council will be adding more specific details to the toolkit, with the goal of presenting their completed work at APNA’s fall 2023 conference.