Columbia Nursing Fall 2019 by Columbia University School of Nursing

Nursing Columbia

The Magazine of Columbia University School of Nursing

Fall/Winter 2019

PALLIATIVE CARE: NOT JUST FOR PATIENTS AT THE END OF LIFE THE STRATEGIC IMPACT OF CHIEF NURSING OFFICERS

THE NURSE PRACTITIONER WILL SEE YOU NOW (VIRTUALLY)

COLUMBIA NURSINGâ&#x20AC;&#x2122;S NEW TELEHEALTH INITIATIVES CONNECT PATIENTS WITH PROVIDERS FACE TO FACE, IN CYBERSPACE.

HELP INSPIRE COLUMBIA NURSING’S NEXT GENERATION By including Columbia Nursing in your estate plans today, with a minimum value of $125,000, you could provide a student with an endowed scholarship in your name. It’s simple, easy, and a once-in-a-lifetime opportunity.

LEAVING A LEGACY “ I believe nursing is the future of health care, and I wanted to support the next generation of Columbia Nursing students.” “— Mary Dickey Lindsay ’45

nursing.columbia.edu/giving/planned-giving For more information, please contact Janice Grady, executive director, development and alumni relations, at 212-305-1088 or jar2272@cumc.columbia.edu.

From the Dean

Preparing Nurses as Doers and Leaders

mong the many advantages of a Columbia Nursing education is solid preparation to respond to an everchanging health-care climate, where clinical complexities reflect an aging, often chronically ill patient population and where value- rather than volumebased care reaps the greatest reimbursements. But preparing nurses to respond to change is only part of what we do. We also prepare them to lead change, as the following stories illustrate. Leading change takes many forms, such as integrating and harnessing innovations in technology to enhance the patient experience, which our first story explores. Telehealth has the potential to increase not only health-care access, but also quality of care, by allowing patients who can’t leave their homes to receive certain types of health care via video link. This is the focus of just a few initiatives that Columbia Nursing faculty members are heading, including a pilot that enables patients at the ColumbiaDoctors Nurse Practitioner Group to follow up in-person appointments with virtual visits. Columbia Nursing’s foray into telehealth includes two initiatives, both in partnership with the Columbia University Irving Medical Center; both virtually connect cancer survivors with their primary care nurse practitioner (NP). One of these pilots also facilitates a three-way video chat so that patients can discuss their care plan and health needs with their NP and their oncologist, together and in real time. On another front, nurses are taking the lead throughout Columbia in the education and practice of palliative care, as well as in important, much-needed research advances in this area. Recognized as a valuable approach to pain and symptom management, especially for end-stage, terminally ill patients, palliative care is also helping individuals with chronic diseases live better, often longer lives, while lowering the costs of care. This includes pediatric patients, who are also living longer with conditions that were once untreatable. Most nurses will eventually care for patients with complex, chronic illnesses; as our second story explains, Columbia Nursing is leading the way in palliative care education by incorporating its principles into all graduate curricula. Additionally, we have dedicated an entire research center to the subspecialty. Our new Center for Improving Palliative Care for Vulnerable Adults with Multiple Chronic Conditions is currently

piloting two studies. One is investigating whether antibiotic use in New York City nursing homes serves the wishes of patients and their loved ones. The other is exploring the use of culturally appropriate, evidence-based palliative care strategies for Chinese-Americans with end-stage renal disease. Finally, our Nurse Practitioner Group is collaborating with the Palliative Care Planning Group to learn if treating congestive heart failure patients with palliative instead of emergency care can improve outcomes and lower costs. Together, these advances in the use of technology and in palliative care exemplify an important evolution in the delivery of care and in nursing—as does the rise of the chief nursing officer (CNO). The role of nurses as senior leaders of health systems has been an evolution over the past 30 years. Today, CNOs like the four Columbia alumni in our third story—who all graduated three decades ago—hold well-earned positions on their institutions’ executive teams. After all, who is better qualified to help navigate health systems than nurses who have the clinical, administrative, research, and budgetary experience that such leadership requires? CNOs have also been in the trenches. They know firsthand what hospitals and other health-care organizations need to perform optimally. They know what type of support bedside nurses need to practice at the top of their license. They know how budget, staffing, or equipment shortfalls can affect patient care. They are equipped to advocate for patients and to make clinical as well as financial recommendations that will promote superior care. It’s no wonder that CNOs have the recognition and respect they deserve as health-care leaders. As dean, I feel tremendous satisfaction when our graduates praise their education for preparing them to address the challenges of a changing health-care system. And I feel particularly proud to know that this education will equip them to lead the changes that will ultimately improve patient care. I hope you enjoy the issue,

LORRAINE FRAZIER, PhD, RN, FAAN Dean, Columbia University School of Nursing Mary O’Neil Mundinger Professor of Nursing Senior Vice President, Columbia University Irving Medical Center

Columbia Nursing is the magazine of the Columbia University School of Nursing and is published twice a year

Nursing Columbia

Lorraine Frazier, PhD, RN, FAAN Dean, Columbia University School of Nursing Mary O’Neil Mundinger Professor of Nursing Senior Vice President, Columbia University Irving Medical Center

Produced by the Office of Strategic Communications and Marketing

Fall/Winter 2019 Contents

Linda Muskat Rim, Editor-in-Chief Associate Dean, Strategic Communications and Marketing Lara Philipps, Production Supervisor Manager, Strategic Communications and Marketing

ALUMNI NEWS EDITORS:

Reva Feinstein, MPA Associate Dean, Development and Alumni Relations Janice Rafferty Grady Executive Director, Development and Alumni Relations Janine Handfus Associate Director, Annual Fund

DESIGN AND ART DIRECTION:

Eson Chan

CONTRIBUTING WRITERS:

Andrea Kott Kenneth Miller

Sharon Sobel Manager, Alumni Relations

Brenda Barrowclough Brodie ’65, RN Durham, NC Paul Coyne ’13 ’15 ’16, DNP, MBA, MSF, RN, AGPCNP-BC President & Co-Founder, Inspiren; Assistant Vice President, Clinical Practice & Chief Nursing Informatics Officer, Hospital for Special Surgery New York, NY Delphine Mendez de Leon ’78, MBA, MPH, RN New York, NY Dorothy Simpson Dorion ’57, MS, RN Jacksonville, FL Angela Clarke Duff ’70, RN Forest Hills, NY Marjorie Harrison Fleming ’69, RN Chair Seabrook Island, SC Susan Fox ’84, MBA, RN President & CEO, White Plains Hospital White Plains, NY Susan Furlaud ’09 ’12, MS, RN New York, NY Ellen Gottesman Garber ’76, RN New York, NY Karen Hein, MD Jacksonville, VT

· DSM-5 Diagnostic Criteria for Autism May Lower Diagnosis Rates · Study Associates Trauma and Cardiometabolic Risk in Sexual Minority Women

BOARD OF VISITORS:

Tina Alvarado ’81, MHA, BSN Rear Admiral (Retired), Senior Health Care Executive, U.S. Navy, Nurse Corps Raleigh, NC

4 Research Roundup

Mary Turner Henderson ’64, RN San Francisco, CA Mary Dickey Lindsay ’45, RN New York, NY Wilhelmina Manzano, MA, RN, NEA-BC Senior Vice President, Chief Nursing Executive, & Chief Quality Officer, NewYork-Presbyterian Hospital and Regional Hospital Network New York, NY Duncan V. Neuhauser, PhD Blue Hill, ME Janet Ready ’81, MBA, MPH, RN, FACHE Chief Operating Officer, St. Joseph’s Health Syracuse, NY Patricia Riley ’76, BS, MPH, RN, CNM, FACNM, FAAN Captain (Retired), U.S. Public Health Service Atlanta, GA Susan Salka, MBA President & CEO, AMN Healthcare San Diego, CA Sara Shipley Stone ’69, MS, RN Brooksville, ME Jasmine L. Travers ’16, PhD, MS, RN Postdoctoral Fellow, Yale University Schools of Nursing and Medicine, National Clinician Scholars Program New Haven, CT

· Nurse Understaffing Is Linked to Patient Infection Risk

22 School News · Alumni Events at a Glance Throughout the Year · Government and Private Research Funding · Selected Faculty Publications

Please address all correspondence to: press.nursing@columbia.edu

Alumni are invited to update their contact information by emailing sonalumni@columbia.edu or calling 212-305-5999

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The NP Will See You Now (Virtually) By Kenneth Miller Columbia Nursingâ&#x20AC;&#x2122;s new telehealth initiatives connect patients with providers face to face, in cyberspace.

Palliative Care: A Whole-picture Perspective By Kenneth Miller Columbia Nursing helps shape and disseminate this evolving field.

The Chief Nursing Officer: A Critical System-level Role for Nursing By Andrea Kott, MPH Changes in the health-care landscape have created a need for a nurse-leader whose clinical, administrative, and budgetary expertise could advance a health-care organizationâ&#x20AC;&#x2122;s strategic vision.

ON THE COVER: Illustration by Davide Bonazzi

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Research

Roundup

G E T T Y IM A G E S

DSM-5 Diagnostic Criteria for Autism May Lower Diagnosis Rates

pproximately one in five individuals who would have received a diagnosis of autism spectrum disorder (ASD) using the previous Diagnostic and Statistical Manual of Mental Disorders criteria (in the fourth edition of the manual) does not meet the more-restrictive diagnostic criteria of the current DSM-5, an analysis from Columbia Nursing suggests. As a result, individuals who have autism-like conditions and remain impaired but lack an official ASD diagnosis may not qualify for necessary services, wrote lead authors Kristine Kulage, MPH, director of research and scholarly development, and Arlene Smaldone, PhD, assistant dean of scholarship and research. “With more than one-fifth of individuals with notable social communication and interaction difficulties, coupled with disruptive, restrictive, repetitive behaviors who will no longer qualify for an ASD diagnosis, clinicians, researchers, and public health officials need to recognize that there are individuals lacking a diagnosis who remain in need of services,” the authors wrote. To assess changes in the frequency of ASD diagnoses following publication of the DMS-5, Kulage, Smaldone, and colleagues conducted a systematic review and metanalysis of 33 studies conducted in the five years since the updated diagnostic criteria were published.

Columbia Nursing Fall/Winter 2019

They found that the more-restrictive criteria of the DSM-5 decreased the incidence of ASD diagnoses, although the decrease was lower than earlier estimates. “This may be because clinicians now have a greater comfort level with interpreting DSM-5 criteria. It could also indicate that fewer individuals are failing to receive an ASD diagnosis than what previous studies anticipated,” they wrote. Citing national data, the authors noted that nearly 30 percent of children in the United States with ASD are not receiving behavioral or medication treatment. It is the failure to diagnose ASD that, in some cases, may impede the timely and intensive treatment associated with improvement, they observed. “Our findings provide further insight regarding how the DSM-5 is being used nationally and internationally to diagnose, or fail to diagnose, those with ASD,” they wrote. “Future research is needed, as concerns remain for impaired individuals who, because of the change in diagnostic criteria for ASD, may no longer qualify for treatment but still demonstrate a need for services.” This study appeared in the March 9, 2019 online edition of the Journal of Autism and Developmental Disorders.

iddle-aged and older sexual minority women (SMW) with a history of trauma are at heightened risk for poor cardiometabolic health, researchers from Columbia Nursing determined. The finding suggests that clinicians should screen SMW for trauma as a risk factor for hypertension and diabetes—key markers of poor cardiometabolic status or cardiovascular disease risk—particularly in middle-aged and older women. “Because SMW are at higher risk for trauma and cardiovascular risk than heterosexual women, we recommend that clinicians consider routinely screening for trauma exposure and other cardiometabolic risk factors in this population,” lead researcher Billy Caceres, PhD, an assistant professor, wrote. Caceres and colleagues analyzed data from the Chicago Health and Life Experiences of Women (CHLEW) Study, a 20-year longitudinal investigation of SMW health, led by Tonda Hughes, PhD, the Henrik H. Bendixen Professor of International Nursing and associate dean for global health. They examined associations between exposure to childhood, adulthood, and cumulative lifetime trauma and psychosocial or behavioral risk factors that contribute to poor cardiometabolic health, specifically obesity, hypertension, or diabetes. The psychosocial risk factors they considered were depressive symptoms, anxiety, PTSD, and low levels of social support; the behavioral risk factors were tobacco use, heavy drinking, illicit drug use, and overeating. The study, which included a sample of 547 racially diverse lesbian and bisexual women, ages 18-75, revealed associations between elevated cardiometabolic risk and all forms of trauma, including physical abuse, sexual abuse, parental neglect, and intimate partner violence. SMW older than 30 generally reported higher rates of childhood and adulthood trauma than younger SMW, suggesting that exposure to childhood trauma increases risk of trauma in adulthood and greater cumulative or lifetime trauma. Both adulthood and lifetime trauma were associated with higher odds of reporting obesity and hypertension, while childhood trauma was significantly associated with higher odds of reporting diabetes. Caceres concluded that providing culturally competent care to SMW requires clinicians to recognize the potential for higher risk of trauma among sexual minority women and the potential impact of such trauma on cardiometabolic risk. This ongoing study is funded by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and appeared in the September 6, 2019 online edition of Journal of Women’s Health.

G E T T Y IM A G E S

Study Associates Trauma and Cardiometabolic Risk in Sexual Minority Women

Nurse Understaffing is Linked to Patient Infection Risk

ospital nurse understaffing may increase patients’ risk for health care-associated infections (HAIs) and reduce overall quality of care, ultimately leading to increased health-care costs, Columbia Nursing research suggests. Patients in units with too few registered nurses (RNs) were 15 percent more likely to develop HAIs on or after the third day of exposure than were patients in units with adequate staffing for day and night shifts, lead author Jingjing Shang, PhD, RN, an associate professor, reported. Such understaffing may produce excessive workloads for on-duty nurses and compromise their ability to conduct important protocols for identifying and preventing urinary tract infections, bloodstream infections, and pneumonia, Shang wrote. In addition to potentially decreasing nurses’ well-being, understaffing may add to annual health-care costs, she added. “As they often serve as coordinators within multidisciplinary health-care teams, nurses play a critical role in preventing HAIs, which is a top priority for improving quality of care and reducing hospital costs.” In a cross-sectional analysis of data from more than 100,000 patients in a large urban hospital system, Shang and colleagues found that 15 percent of patient days had inadequate RN staffing levels during daytime shifts, while 6.2 percent of patient days had RN understaffing during both day and night shifts. Units with licensed practical nurses and nurse assistants were also understaffed, which contributed to patients’ increased risk of HAIs, the researchers found. HAIs are serious but often preventable problems associated with high morbidity and mortality. Approximately 4 percent of patients have one or more HAIs during their hospital stay. To help lower health-care costs, the U.S. government has taken steps to curb the incidence of HAIs. Wrote Shang, “Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care.” In addition to Shang, the study’s other Columbia Nursing authors were: Jianfang Liu, PhD; Elaine Larson, PhD; and Patricia Stone, PhD. This study was funded by the National Institute of Nursing Research and appeared in the May 2019 edition of The Journal of Nursing Administration.

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Columbia Nursing Fall/Winter 2019

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THE NP WILL SEE YOU NOW

(VIRTUALLY) BY KENNETH MILLER

n a recent Sunday morning, Elizabeth Craig was jolted from sleep by the worst pain she’d ever experienced. It felt as though someone had plunged a knife into the left side of her lower back and was slowly probing her innards. Unable to walk across the bedroom, the 55-year-old school administrator lay writhing on the floor; she began to vomit, but emptying her stomach brought no relief. Suspecting a kidney stone, Craig’s wife drove her at high speed to a hospital near their apartment in Brooklyn, where doctors confirmed that diagnosis and administered morphine. After five hours in the emergency room, Craig’s condition had stabilized enough that she was able to return home. Because the stone had not yet passed, she was advised to see a urologist for follow-up care. But first, she would need a referral from her primarycare provider—Columbia Nursing assistant professor Caroline Sullivan ’13, DNP, who sees patients at the ColumbiaDoctors Primary Care Nurse Practitioner Group practice on West 51st St. When Craig called the office for an appointment, she learned that the earliest available slot was a week later. Though still in considerable discomfort, she resigned herself to wait. Soon afterward, however, the clinic called back to offer a quicker alternative: a telehealth visit, which connects patient and provider via live video. Just two days after her ER trip, Craig sat in her living room and clicked on an app on her mobile phone. Within sec-

COLUMBIA NURSING’S NEW TELEHEALTH INITIATIVES CONNECT PATIENTS WITH PROVIDERS FACE TO FACE, IN CYBERSPACE.

onds, Sullivan was on the screen—asking about Craig’s symptoms, the procedures she’d undergone, and the medications she’d been prescribed. Sullivan then discussed possible next steps for Craig’s treatment and offered referrals to two Columbia urologists. The consultation took about 15 minutes, sparing Craig a long round trip to Midtown. “It was not taxing, which was what I needed at that point,” she recalls. “Riding the subway, or an Uber, would have been miserable.” Craig’s virtual visit was part of a series of new initiatives through which Columbia Nursing faculty members are harnessing telehealth to enhance patients’ access to care. “Although NewYork-Presbyterian has long been a leader in this modality, using it to connect patients with specialists, we’re among the first outpatient providers at the medical center to pilot it,” says associate dean of clinical affairs Stephen Ferrara, DNP, RN, who oversees the Nurse Practitioner Group (NPG), the school’s primary care faculty practice. “We think there’s great potential to grow with this. The possibilities are really endless.”

hose possibilities reflect some broad trends in U.S. health care, including the dwindling number of medical school graduates who go into primary care, the aging of the population, and the growing prevalence of chronic physical conditions and mental health disorders. Such factors are leading to provider shortages in many parts of the country, plus longer wait times

ILLUSTRATIONS BY DAVIDE BONAZZI

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THE NP WILL SEE YOU NOW (VIRTUALLY)

(both for appointments and at physicians’ offices) almost everywhere. A recent Harris Poll survey found that 23 percent of Americans have delayed seeing a doctor because it takes too long. Meanwhile, healthcare costs continue to skyrocket—in part because of unnecessary provider, urgent-care, and emergency-room visits. Telehealth can address all these problems, by offering a safe, effective, less–time-consuming, and lower-cost alternative to many in-person visits. As a result, the proportion of hospitals using the technology has risen from 35 percent to 76 percent since 2010. And as NPs become increasingly essential to easing the nation’s provider drought, telehealth can help them serve patients far more efficiently. The Nurse Practitioner Group’s telehealth pilot began in April. The protocol is simple: After a patient has had an in-person appointment at one of the practice’s locations, in Midtown or Washington

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TELEHEALTH doesn’t just connect patients with providers—it can also be used to coordinate care between different providers for the same patient.

Heights, follow-up visits are performed by video link whenever that’s deemed appropriate. The visits use an app that works much like Skype or Facetime. Developed by the Boston-based telemedicine company American Well, the software is HIPAA-compliant and is designed to obstruct eavesdropping and hacking. Sessions can be conducted on smartphones, tablets, or computers. The patient signs in by clicking on a “start visit” icon; the provider then receives an alert that the person has entered the virtual “waiting room” and begins the consultation by clicking on his or her own screen. So far, six of the practice’s nine NPs have received simulation training on the technology, with an emphasis on “web-side manner” (such as how to maintain eye contact and conversation flow while taking notes for the patient’s electronic health record), as well as on more technical matters. The goal is to train the remaining providers and complete the rollout by early 2020. Ultimately, Ferrara suggests, perhaps 25 percent of the group’s patient visits may include a telehealth component. Besides using it in cases like Craig’s, the Nurse Practitioner Group expects to employ the app in a wide range of contexts. “For patients with hypertension, we might start them on medication and then supervise blood-pressure tests at home, where readings tend to be more accurate than in the office,” Ferrara explains. “Telehealth also works well for tracking skin conditions. Because it allows us to see whether the symptoms are resolving, we can assure the patient that a prescribed treatment is working—or adjust it if necessary. We could do something similar with migraine headaches, having patients walk a straight line or perform other neurological maneuvers to help us evaluate their symptoms. For elderly patients, we’ll be able to check their living environments for fall risks, or have them show us their medicine bottles—making sure they match our records and reducing the risk of harmful drug interactions.”

Columbia Nursing Fall/Winter 2019

To date, however, the group has used telehealth most often for mental-health consultations—an effort spearheaded by Sandra Alvarado ’76, MS, a psychiatric nurse practitioner and certified therapist with over 40 years of advanced clinical practice. “I put out feelers to my patients as soon as the pilot was proposed and got a lot of positive responses,” says Alvarado, who is based at the Washington Heights practice. “Many of them work full-time, and it can be incredibly hard to get away from the office. Several commute from the Columbia campus on 116th St. by public bus, and they would miss appointments because it took so long to get here. Or they’d be so worried about getting back to work on time that they couldn’t focus during therapy sessions. Now, they’re able to call in on their lunch break from their desk or any other quiet place, which makes for a much more stress-free interaction.” Patients can also consult with their providers via telehealth about medications they’ve been prescribed for certain mental health disorders, such as anxiety and depression. “We’ll discuss whether they feel their dose is working, and if they’re having any side effects,” explains Caroline Sullivan. “We often talk about alternative therapies that might help with their problem, such as exercise or better sleep hygiene. I use a screening tool to check for symptoms. And by looking at patients’ faces, I get information about their psychological state that wouldn’t come through in an ordinary phone conversation.” Telehealth has proved especially popular among patients taking controlled substances for attention deficit hyperactivity disorder (ADHD). Federal regulations allow a maximum 90-day prescription for such drugs, and the Nurse Practitioner Group requires patients to meet with their provider for refills. They can now do that remotely, instead of coming in to the clinic.

elehealth doesn’t just connect patients with providers—it can also be used to coordinate care between different providers for the same patient. That makes it a key element of another pilot project recently launched by the Nurse Practitioner Group, in partnership with the outpatient hematology-oncology practice at Columbia University Irving Medical Center: a survivorship clinic for Medicare patients who have completed initial treatment for prostate cancer. Such clinics are mandated for all cancer survivors by the Center for Medicare and Medicaid Service’s new Oncology Care Model, aimed at improving efficiency and lowering costs in case management. Yet prostate cancer survivors have unique health-care needs, which Columbia’s clinic—the first in the nation to link these patients remotely with primary-care NPs and specialists—is meant to address. “The side effects of common prostate cancer therapies can include sexual dysfunction, incontinence, and bowel problems,” explains assistant professor Maura Abbott, PhD, RN, a nursing director in the heme-onc practice, who developed the survivorship clinic with Stephen Ferrara. “For men prescribed hormone therapy to keep their cancer from coming back, there’s also an increased risk of diabetes, hypertension, and cardiovascular disease,” continues Abbott. “Patients may suffer from related mental-health issues and social stigma as well. Nurse practitioners are ideal primary-care providers for these survi-

vors, because we’re trained to focus on the whole person rather than just the disease. But it’s crucial that all the patient’s health-care providers work together closely to ensure the best possible outcome.” That’s where telehealth comes in. When a patient first enrolls in the survivorship clinic, he meets with his oncologist at NewYorkPresbyterian and with an NP from the Nurse Practitioner Group, who participates via video chat from the group’s 168th St. practice location. The patient and these providers spend up to an hour developing a care plan tailored to his particular needs, based on guidelines recommended by the American Society of Clinical Oncology. From that point on, the NP serves as the patient’s primary-care provider. But if he has a concern best addressed by an oncologist—“a lump, a bump, or any other symptom that might be related to their cancer,” says Abbott—another joint telehealth visit can be scheduled, from either the NP’s office, the patient’s home, or anywhere else with an internet connection. The project’s short-term goal is to sign up 40 to 50 prostate cancer survivors; eventually, men with other types of genitourinary cancer (including of the bladder and kidney) may be added as well. “For a population like this, convenience is essential to getting buy-in,” Abbot notes. “These men often have low health literacy, and many received little or no primary care before their cancer diagnosis. Because of their illness, they’ve already spent too much time away from their work and their families. They may not have the energy to travel around the city

from provider to provider, or the money for cab fare or parking fees. Using telehealth lets us bring care to these patients instead of making them go out and chase after it. We’re respecting what they’ve been through, as well as their ongoing struggles.”

atients, of course, aren’t the only ones who can benefit from telehealth. The technology enables clinicians to work smarter, too—spending less time on preparing exam rooms for patient visits, for example, and avoiding costly no-shows. One Nurse Practitioner Group provider, Katherine Clark ’14 ’16, MSN, plans to use the app for another efficiency-boosting purpose: transitioning back into the workforce after maternity leave. Furthermore, improving workflow for providers can be good for society at large, by lowering costs and other barriers to health care. “Telehealth is part of a growing movement away from the notion that health care has to happen in a practitioner’s office or a hospital unit to be effective,” says Ferrara. “It’s one more tool that, when used in the right situation and with the right patient, helps us provide better care.” Elizabeth Craig, who has recovered fully from her kidney stone, would be happy to try that tool again under less painful circumstances—perhaps for an upcoming visit to discuss her antidepressant dosage. “I’m not someone who needs to sit in an office and chat with my provider,” she says with a laugh. “So telehealth works pretty well for me.” 

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Palliative care education begins during students’ first-year and is integrated into the curricula of all graduate programs, a policy enacted by the school’s Palliative Care Planning Group, which includes faculty members Karol DiBello, DNP, Mary Ellen Tresgallo, DNP, Penelope Buschman, MS, and Marlene McHugh, DNP.

PHOTOGRAPHS BY JÖRG MEYER 10

Columbia Nursing Fall/Winter 2019

PALLIATIVE CARE: A WHOLE-PICTURE PERSPECTIVE

Columbia Nursing helps shape and disseminate this evolving field.

BY KENNETH MILLER

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f you want to peer into the future of palliative care nursing, a good place to start is the ColumbiaDoctors Primary Care Nurse Practitioner Group on West 168th St. This morning, Debra Miller-Saultz ’10, DNP, an assistant professor of nursing, is examining a patient who embodies many of the changes sweeping the field. A 69-yearold immigrant from Southeast Asia, the woman has a passel of comorbid conditions. She sees nine specialists, including an endocrinologist for her diabetes, a cardiologist for her heart disease, and a nephrologist for her kidney problems. A neurologist treats her neuropathy and the effects of a mild stroke. Then there’s an ophthalmologist for her retinopathy, a urogynecologist for her incontinence, and the list goes on. The woman has come in today because of swelling in her lower legs. Miller-Saultz checks the patient’s labs and performs a physical exam. But as a fellowship-trained palliative care specialist, she also asks some questions that most other practitioners might not think of: “Who’s managing your medications? How’s your mobility? How are you handling house-

hold chores?” It emerges that the woman’s caregiver, her sister, is away in their home country. As a result, the patient has been eating salty, greasy takeout—which may be why her blood pressure and cholesterol are soaring. Her blood sugar levels suggest she may also need assistance administering her insulin shots. She says she could use help cleaning her apartment, too. Besides referring the woman to a vascular surgeon for evaluation of her lower extremity venous insufficiency, Miller-Saultz schedules a house call by one of the practice’s NPs to further assess her situation. “Everybody takes care of their little piece of this lady, but nobody’s really looking at the whole picture,” she explains after the patient hobbles out. “That’s what palliative care is for.” Who palliative care is for is a less settled matter. When Miller-Saultz first entered the discipline, in the early 2000s, it was mainly associated with the hospice movement and specialist care for pain and symptom management; its mission was to bring comfort to terminally ill patients in their final days. Lately, however, the aging of the U.S. population, along with the rising incidence of chronic illnesses—as well as the advent of life-extending treatments for various pediatric conditions—has led to an increasing use of palliative approaches for patients whose deaths may be years away. Reflecting that shift, a 2018 report by the National Consensus Project for Quality Palliative Care offered an expanded definition of the field: “Beneficial at any stage of a serious illness, palliative care is an interdisciplinary care delivery system designed to anticipate, prevent, and manage physical, psychological, social, and spiritual suffering to optimize quality of life for patients, families, and caregivers.” It can be delivered in settings ranging from inpatient floors to outpatient centers, from private homes to rehab facilities. Research shows that it can help patients live better, and often longer, while lowering the costs of care. Still, according to a study in the New England Journal of Medicine, nearly 60 percent of those who could benefit from such care don’t receive it. Over the past year, Columbia Nursing has launched an array of initiatives aimed at closing that gap—and helping prepare the field for the challenges ahead.

“W

Debra Miller-Saultz, DNP

Columbia Nursing Fall/Winter 2019

hat makes palliative care so powerful is that it focuses on the patient rather than the disease,” says Penelope Buschman ’64, MS, RN, a retired assistant professor of clinical nursing. “We see it as a philosophy of care as well as a system of services. And our goal is to integrate that philosophy at every level of nursing education, as well as nursing research and clinical practice.” Columbia has been a leader in that effort since 2003, when Buschman, then director of the psychiatric nurse practitioner program, helped establish one of the country’s first subspecialty programs in palliative care nursing. The program, which has both adult and pediatric tracks, is open to NPs in

Patricia Stone, PhD, RN

“Palliative care is a partnership with patients and their families,” says Buschman. “It means not just understanding physiology and disease trajectory, but knowing how to listen, be present, and respect people’s needs and wishes.

all specialties; its curriculum includes an introductory course, a clinical rotation, and a seminar in which students discuss issues that arise during their clinical rotation. In 2013, Columbia Nursing added a Fellowship in Palliative and End-of-Life Care, funded by the Louis and Rachel Rudin Foundation. One of just a handful of palliative care nursing fellowships in the U.S., it’s designed for doctoral and postdoctoral NPs who aim to specialize in palliative care— whether in clinical practice, in the health-care policy arena, or as educators. Fellows are placed in a variety of palliative care settings until they accrue at least 500 clinical hours. Course topics include advanced pain and symptom management, care planning, bereavement support, self-care, therapeutic communication, and the ethics of dealing with patients and family members when they are at their most vulnerable. Students learn partly by example, watching experienced faculty members make difficult care decisions or discuss sensitive issues with a patient’s loved ones; later, they take on such responsibilities themselves, under a mentor’s watchful eye.

But in recent years, it has become clear that such expertlevel programs aren’t enough. “We realized that most of our students are going to be dealing with complex chronic illness,” says Marlene McHugh ’89 ’91 ’08, DNP, a fellowshiptrained associate professor of nursing and a co-founder of both the subspecialty and the fellowship. “That means everybody needs to have these skills.” So in April 2018, the school announced that it would incorporate the principles of palliative care into the curricula of all its graduate programs. The new policy is the brainchild of the school’s Palliative Care Planning Group, led by Buschman; other members of the group are McHugh; Miller-Saultz; assistant professor Mary Ellen Tresgallo, DNP (another program co-founder); and assistant professor Karol DiBello, DNP. Palliative care education now begins during the first-year Care Coordination course taken by every MDE, NP, and DNP student. Along with classroom work, students must complete six online End-of-Life Nursing Education Consortium modules developed in partnership with the American Association of Colleges of Nursing. The modules introduce concepts covered in more advanced palliative care courses—in part to draw more students toward the field, but also to equip those going into general practice with an increasingly essential set of tools. “Palliative care is a partnership with patients and their families,” says Buschman. “It means not just understanding physiology and disease trajectory, but knowing how to listen, be present, and respect people’s needs and wishes. It requires acceptance of the fact that every human being responds differently to the experience of disease or major injury. Our job is to provide information and help with decision-making, but never to impose.”

mpathy and openness are essential—but not sufficient— for successful palliative care. One of the biggest challenges in the field is determining which care practices produce the best results for different subpopulations of patients, particularly older adults with multiple chronic conditions (MCCs). Such patients, known as “superutilizers,” account for 93 percent of Medicare spending. They are likely to have more complications and longer hospital stays than others their age and to experience end-of-life crises that result in higher costs without generating significant gains in quality of life or survival—and, indeed, sometimes causing increased suffering. Another new venture at Columbia Nursing, the Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC), supports nurse-scientists seeking better ways to care for superutilizers. A partnership with the Visiting Nurse Service of New York (VNSNY), funded by a $2.7 million grant from the National Institute of Nursing Research (NINR), the CIPC is co-directed by Patricia Stone, PhD, RN, the Cen-

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tennial Professor of Health Policy, and Jingjing Shang, PhD, RN, an associate professor of nursing; Columbia Nursing researcher Maxim Topaz, PhD, RN, the Elizabeth Standish Gill Associate Professor of Nursing, is the principal investigator of the VNSNY site. “We’re promoting what the NINR calls ‘the science of compassion,’” Stone explains, “especially as it applies to end-of-life care.” The CIPC is currently sponsoring two pilot studies. The first, led by assistant professor Eileen Carter ’14, PhD, RN, is investigating antibiotic use in New York City nursing homes to determine whether it serves the wishes of patients and their loved ones. Carter’s team is investigating why and how often these medications are being administered and whether patients and family members fully understand the drugs’ risks (such as adverse reactions and opportunistic infections), as well as their potential benefits. The second study, designed by associate research scientist Carolyn Sun ’15, PhD, RN, is looking into how Chinese-Americans cope with end-stage renal disease, with the goal of developing cul-

turally appropriate, evidence-based palliative care strategies for this underserved population. Recently, the NINR announced the availability of supplemental funding for research centered on bioethics. The CIPC responded with a proposal by associate research scientist Bevin Cohen ’17, PhD, RN, for a study examining issues related to end-of-life care for patients who are unable to make their own decisions and who lack advance directives or surrogates who can speak for them. Cohen, who holds a joint appointment at Memorial Sloan Kettering Cancer Center, calls such patients INEADS (pronounced “in needs”), which stands for incapacitated with no evident advance directives or surrogates. “When life-and-death decisions have to be made, the health-care team has no way to know an INEADS patient’s needs and wishes,” says Cohen. “We suspect this is a growing phenomenon. But very few studies have been done on these patients, so no one even knows how many there are, let alone how providers deal with them.” If Cohen’s study is funded, whether through the NINR supplement or other means, she and her team will work toward answering both questions. To probe the quantitative aspects of the issue, they’ll use natural language processing programs to analyze electronic health records from two databases: one of 39,000 patients treated at a Boston hospital, the other of 89,000 home-care patients seen by the VNSNY. To understand the issue’s qualitative aspects—how clinical decisions are made in INEADS situations and how those decisions affect all those concerned—the team will conduct focus groups with providers and bioethicists, as well as interviews with individuals identified as being at risk of becoming INEADS patients. For Cohen, gathering such data is more than a matter of mere curiosity. She has a particular interest in the ethical choices associated with palliative care. “When I was doing clinical rotations in nursing school, I saw too many patients at the end of life entering a trajectory that no one would wish for,” she explains. “I remember one woman who was on a ventilator, in restraints, and extremely agitated. I found out she had metastatic breast cancer and AIDS, and she was homeless due to psychiatric illnesses. She’d made a suicide attempt, but EMS had found her and she’d wound up alone, tied to a machine, and absolutely miserable. There’s a human cost to that, but also a health-care cost that we all end up paying. If we can redesign the system to make sure people receive the kind of care they want, everybody wins.”

T Bevin Cohen, PhD, RN

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he notion of improving outcomes while lowering costs is also central to a pilot project getting underway at the ColumbiaDoctors Primary Care Nurse Practitioner Group’s primary care practice. This initiative—led by Stephen Ferrara, DNP, RN, associate dean of clinical affairs and associate professor of nursing, in conjunction with the Palliative Care Planning Group—targets Medicare patients whose use of

ists and will hold regular care-review meetings. Patients in the program will be prioritized for completing advance care directives. And they’ll be fast-tracked for appointments (or, eventually, telehealth consultations), reducing their temptation to race off to the ER. “We’ve found that most patients would actually rather not go to the hospital,” says Ferrara. “By expanding our intervention tool chest, we may be able to help them do just that.” Like most clinical initiatives at Columbia Nursing, this one will be studied carefully by in-house researchers, who will measure its effects not only on emergency-department visits but also on hospital lengths-of-stay and patient satisfaction. If it works, Ferrara says, “we hope to offer this model to all our high-risk patients. We want to make it part and parcel of our practice.”

O Stephen Ferrara, DNP

“For me, palliative care brought together all the things that drew me to nursing—not just the medical, but the emotional, spiritual, and psychological elements.”

health-care resources is exceptionally high. Using data from NewYork Quality Care (the accountable care organization for NewYork-Presbyterian, Columbia’s Vagelos College of Physicians and Surgeons, and Weill Cornell Medical College), the team has identified 20 such patients who receive their primary care from the 168th St. location. “We’re looking at people who might have been diagnosed with congestive heart failure, and they call 911 when their breathing gets a little more difficult,” Ferrara explains. “They wind up spending hours in the emergency room, getting a battery of tests, and being admitted for observation, when all they really needed was a diuretic pill. We want to spare them that experience.” To that end, the Nurse Practitioner Group plans to systematically incorporate palliative approaches into the care these patients receive. All 20 will be cared for by Miller-Saultz and two other seasoned NPs—assistant professor of clinical nursing Marie Carmel Garcon, DNP, RN, and instructor in nursing Yudelka Garcia ’12 ’14, MS, RN, who are both receiving additional training in palliative care. These providers will also have on-call access to the faculty’s palliative care special-

ver the years, the school’s leadership in palliative care nursing research, practice, and education has made waves far beyond the campus, whether by providing crucial data, establishing treatment protocols, or sending superbly trained graduates out into the world. One of the latter is Vanessa Battista ’06 ’08, MS, RN, who enrolled at Columbia Nursing after a stint as a research coordinator for patients with amyotrophic lateral sclerosis. That experience inspired her to enter the palliative care subspecialty program. “One of my ALS patients had told me, ‘Having this disease makes me wonder how there could be a God,’” she recalls. “For me, palliative care brought together all the things that drew me to nursing—not just the medical, but the emotional, spiritual, and psychological elements.” After earning a master’s degree and board certification as a pediatric nurse practitioner, Battista worked as a clinical coordinator at Columbia University Irving Medical Center, then completed a certificate in pastoral ministry at Boston College. In 2010, she joined the faculty of BC’s William F. Connell School of Nursing, where she developed a pediatric palliative care master’s subspecialty. The integration of palliative-care concepts into pediatrics represents another of the evolving aspects of the field. Whereas palliative care was once envisioned as a resource mostly or even solely for older people, it is now being integrated into care for children and even infants who could benefit from the “whole-picture” perspective that distinguishes the field. “The beauty of this kind of nursing is that you’re looking at all the pieces of what makes a person a person,” says Battista, who’s currently pursuing her DNP at the Johns Hopkins School of Nursing. “But I might never have discovered that if it hadn’t been for my teachers at Columbia Nursing, who believed in me and fostered my growth. Mentors like Penny Buschman not only awakened my passion for palliative care, but they showed me how to put it to work. Being around these brilliant, caring people shaped the clinician I am today.” 

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The Chief Nursing Officer:

A critical system-level role for nursing By Andrea Kott, MPH

he nursing career that Kevin Browne ’92, DNP, RN, envisioned more than 30 years ago focused on alleviating suffering, one patient at a time. Back then, Browne specialized in critical care, working with post-surgery cardiothoracic patients. “I believed I had a great capacity to give,” he says. Over the years, Browne found that he also had a bent for leadership, which earned him charge nurse and committee head appointments at the hospitals where he worked. “I realized I had the capacity to lead a nursing service,” says Browne, now deputy chief nursing officer (CNO) at Memorial Sloan Kettering Cancer Center in Manhattan. More importantly, he realized that being a nurse leader exponentially increased his ability to serve patients by positioning him to help shape the delivery of care systemwide. “When I became a head nurse, I realized that I could influence many of the nurses who were delivering care, as opposed to influencing just one patient. As a director, I could influence hundreds of nurses. And now, as deputy chief nursing officer, I can influence thousands.” The opportunity for nurses to influence patient care by helping to shape and navigate health-care systems is a relatively recent phenomenon—an answer to a 2011 report by the Institute of Medicine. That report, titled The Future of Nursing: Leading Change, Advancing Health, called for strong leadership to transform health care by increasing quality, accessibility, effectiveness, and cost efficiency. It spoke forthrightly to the nursing

profession as a major force in the patient experience and paved the way for CNOs like Browne and others—including Kerri Scanlon ’93 ’97, MSN, RN; Mary Ann Donohue-Ryan ’98, PhD, RN; and Frances Cartwright ’92 ’93, PhD—to advance its mandate. This is, they all agree, vital to improving the care that every patient receives. “CNOs are critical to the movement of health-care organizations,” Browne says. “You cannot deliver quality patient care with high performing outcomes and metrics without them.” A profession of doers and leaders Nursing has always been a profession of doers and leaders. In addition to serving as the primary providers of hands-on care, nurses have long held leadership roles in education and policy, while their important work as patient advocates has made NPs leaders in practice. But changes in the health-care landscape—including shrinking reimbursements, the shift from volume-based to value-based care, and the aging and increasing clinical complexity of the American population—have created a need for a special type of nurse-leader: one whose clinical, administrative, and budgetary expertise could advance a health-care organization’s strategic vision. “It became a mandate that there needed to be one nurse at the helm of nursing services, someone who would be required to maintain clinical and patient-care standards; to ensure that patients were receiving safe, accurate, highquality care; and to see that dollars were there to support

Photographs by Jörg Meyer

Kevin Browne, DNP, RN

the resources needed to meet the changing volume and acuity of patient populations,” Browne says. This “one nurse,” the CNO, has a 360-degree understanding of how a hospital or other health-care organization works and is therefore a critical member of the executive leadership team, says Scanlon, CNO for North Shore University Hospital in Manhasset, N.Y., and deputy CNO for Northwell Health. “The CNO is the person who completely understands not only the care being provided but also the entire milieu and perspective of an organization and how it provides care,” Scanlon says. Scanlon began her career as a medical-surgical nurse and went on to specialize in critical care, working in cardiothoracic intensive care and as a critical-care educator. “I never said, ‘I want to be the CNO of a hospital,’” she recalls. She accepted the assistant directorship of a systems quality department, then became assistant vice president for corporate quality, and, finally, was named CNO. “I’ve been in charge of medical records, case management, social work, and pharmacy,” she says. In her current position, Scanlon works closely with Northwell Health’s nurse executive team to establish the strategic vision for nursing and patient care services across the 23-hospital health system. “It’s the most phenomenal job I’ve ever had,” she says.

Columbia Nursing Fall/Winter 2019

Before the women’s movement, a male health-care executive would likely have held Scanlon’s job, but since then, leadership opportunities for women have flourished, Donohue-Ryan says. “The ability of nurses to influence care at the bedside is a direct result of the opportunities that have been afforded to women in the workplace, especially leadership development, over the past 30 years.” Because of these expanded opportunities, nurses like Donohue-Ryan have been able to practice clinically, while also holding leadership positions. “My personal goal wasn’t to choose between leadership and clinical care,” says Donohue-Ryan, who was CNO at several hospitals in New Jersey (Englewood Hospital and Jersey Shore University Medical Center) and New York (Stony Brook University Hospital), and is now a consultant at the Chilton Medical Center in Pompton Plains, N.J. and at White Plains Hospital in Westchester, N.Y. “The position that launched my administrative career was a director of nursing position for behavioral health, while I also functioned as an advanced practice nurse,” Donohue-Ryan says. She notes that the women’s movement is just one of the factors—along with the changing health-care economy, the inception of the American Nurses Association’s Magnet Recognition Program, and influential

Kerri Scanlon, MSN, RN

organizations like the American Association of Nurse Leaders—that spawned and nurtured the emergence of the CNO as a full-fledged executive leader, equivalent to other senior hospital administrators in function and authority. “In a Magnet organization, nursing leaders must be peers to every other senior executive around the boardroom table, with the same 24/7 accountability, and access to the president and CEO.” Ensuring such accountability is essential in today’s health-care marketplace, where outcomes drive reimbursement rates, according to Cartwright. “Nursing is in a pivotal position to lead the redesign of healthcare delivery so that we keep our patients safe, while delivering patient-centric, excellent-quality care,” she says. “We need CNOs to be at the table to advance health-care policy and influence changes that include the voices of the patient, family, and community, while considering social determinants of health. Continued investment in the practice of nursing so that all nurses practice at the top of their license in a culture of safety is key to making this paradigm shift.” Cartwright, the CNO at Mount Sinai Hospital in Manhattan, began her career as an oncology nurse. “It wasn’t on my bucket list to be a CNO,” she says. As she progressively assumed more and more significant lead-

“ We need CNOs to be at the table to advance health-care policy and influence changes that include the voices of the patient, family, and community, while considering social determinants of health.” ership roles, she found that being an executive leader allowed her to influence organizational excellence. “My major aim is always to support and invest in frontline nurses,” she says. “It is the frontline nurse who partners with the patient and family to make that personal connection so that individuals’ needs, concerns, and desires are considered. They help us keep patients safe and provide them with quality care.” Supporting frontline RNs Among the CNO’s key functions is championing the critical role of frontline RNs by giving voice to their needs, from increased staffing to continuing education. Importantly, the CNO’s role also includes conveying RNs’ perspectives about their patients’ needs for equipment and other resources, Donohue-Ryan adds. “The CNO connects the dots between decisions that are often

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Mary Ann Donohue-Ryan, PhD, RN

“Nurses in leadership positions ought to be educated at the top of their license, yet we have a shortage of qualified PhD faculty in nursing schools across the country to do the teaching,” Donohue-Ryan says. based on financial reasons and how those decisions translate into the best-quality patient-care outcomes.” Connecting the dots—that is, conveying how quality is always connected to financial decisions—is not always easy among colleagues who are equally concerned about maintaining the bottom line but may need help navigating the language of professional and regulatory standards, Donohue-Ryan notes. This could be the case, for example, if meeting patients’ needs requires a certain level of staffing that exceeds an institution’s budget, she explains, or if staffing levels seem excessive in outpatient areas where nurses appear to a nonclinical manager, director, or executive to be monitoring patients, rather than constantly performing critical assessments as they care for a problem-prone, high-risk, vulnerable population. “Nurses perform rapid evidence-based assessments every time they are

Columbia Nursing Fall/Winter 2019

involved in patient care, so there is no such thing as an educated, licensed nurse whose function is restricted to reporting only preset parameters,” Donohue-Ryan says. Even requests for supplementary nursing education may strike some as superfluous. “I remember one colleague early in my career who asked why staff nurses would ever need simulation education for hands-on learning,” Donohue-Ryan recalls. “He asked, ‘Why can’t they sit in front of a computer and point and click? Didn’t they get what they needed in nursing school?’” In addition to championing nurses’ clinical practice needs, CNOs support their participation in legislative affairs and institutional policy- and decision-making, all of which are essential in helping nurses understand and embrace the rationale behind their work, Donohue-Ryan adds. “Shared decision-making actually is proven to help guide administrative decisions to prepare better informed executives.” Having decision-making input deepens nurses’ engagement with their work, Cartwright says. “We need the critical thinking skills, passion, and experience of the frontline nurses to innovate changes in process and structures to improve care and, in turn, the overall patient experience,” she says. Policies and procedures that promote nurse autonomy and clinical ladders to provide

Frances Cartwright, PhD

career advancement at the bedside are two examples of how nurse leaders invest in and support nurses. Such support promotes increased nursing engagement and reduces job dissatisfaction and attrition, sparing hospitals and other health-care institutions the financial burden of constant recruitment. Plus, Cartwright adds, it attracts new nurses. “Engaged nurses are talent magnets,” she points out. A pivotal role in positive change In the years since she became a CNO, Scanlon says she has seen many productive changes in health care, most notably the demand for big data. “In 1999, medical error contributed to the deaths of 90,000 hospital patients in the United States,” she says. To reduce spending on potential medical errors, payers began basing reimbursements on outcomes data, which heightened the requirement for provider accountability. Leveraging such data to justify reimbursement rates and drive quality improvement initiatives is among Scanlon’s many responsibilities as CNO. Indeed, big data allowed her to design and lead initiatives at North Shore University Hospital that, among other things, decreased the incidence of pressure ulcers by 90 percent and produced a 45 percent improvement in the rate of patient falls. “CNOs know what needs

to occur not only in terms of business and finance but also, and most importantly, in developing models of care that are going to drive desired outcomes,” she says. “To me, that’s the greatest indicator of exceptional nursing.” Despite CNOs’ increasingly pivotal role in transforming health care, many agree that there remains some resistance toward having a CNO—or any nurse—at the executive table. “We’re still evolving toward universal recognition of nurses as leaders,” Scanlon says. “I’ve been quite fortunate in my career in that our organization has valued nursing leadership presence at the table.” What’s more, even organizations that promote nursing leadership do not always have the tools they need to develop it. “Nurses in leadership positions ought to be educated at the top of their license, yet we have a shortage of qualified PhD faculty in nursing schools across the country to do the teaching,” Donohue-Ryan says. The good news is that the growing opportunities awaiting CNOs, and the strides they are making in improving patient care, outweigh the hurdles they face. “We’re leaders because of who we are, not just what we do,” Browne says. “We’re not just deliverers of care who alleviate suffering. We are executives who have a sphere of influence that was unrecognized years ago but is more recognized every day.” 

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3 1 2

ALUMNI EVENTS AT A GLANCE

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Columbia Nursing Fall/Winter 2019

1: New and current students at the 2019 New Student Welcome Breakfast. 2: Dean Lorraine Frazier presenting Suzanne Law Hawes ’59 with the inaugural Anna Caroline Maxwell Award, selected at the discretion of the dean, at the 2019 Alumni Reunion. This award is conferred upon an alumnus/a whose achievements and record of service exemplify the ideals and traditions of the school and its founder. 3: Richard D. Simmons and Susan Diamond with student Qian Kun Tan ’19, the Mary Bleecker Simmons ’60 Nursing Scholar, at the 2019 Annual Dean’s Dinner. 4: Natalie Stark, Tyler McClelland ’19, and Kristen Conti ’19 at the 2019 Columbia Nursing–NewYork-Presbyterian Networking Event. 5: Members of the Class of 1969 celebrate their 50th reunion. 6: Susan Fox ’84 and Janice Bistritz ’84 ’14 at the 2019 Alumni Reunion. 7: Students lead tours of the ColumbiaDoctors Primary Care Nurse Practitioner Group at the 2019 Alumni Reunion. 8: Mari Arnaud, Mark Bertolini, Shanelly Singh ’18, and Dean Lorraine Frazier at the 2019 Mark Bertolini Event.

11: Students demonstrate a laborand-delivery simulation at the 2019 Alumni Reunion. 12: Ellen Nadel ’15 ’18 and Rachel Zisman ’16 ’18 at the 2019 Alumni Reunion. 13: Shazia Mitha ’16 ’18, Shanelly Singh ’18, Mark Bertolini, Ashley Belfort, Julie Yoshimachi ’17 ’19, and Victoria Scigliano at the 2019 Mark Bertolini Event. 14: Dennis Flanagan with student Rebecca Tran ’17 ’19, the Abigail Flanagan ’13 ’15 DNP Scholar, at the 2019 Annual Dean’s Dinner.

15: Eileen Carter ’14, Vepuka Kauari, and Elaine Larson at the 2019 Columbia Nursing–NewYork-Presbyterian Networking Event. 16: Distinguished Alumni Award winners Sarah Collins Rossetti ’09, Judith Mercer ’74, Elaine Larson, Linda Kivowitz Glazner ’64, Nessa Coyle ’81, Elizabeth Cooper ’71, Don R. Boyd Jr. ’06 ’17, and Tener Goodwin Veenema ’80 at the 2019 Alumni Reunion.

17: New and returning students at the 2019 New Student Welcome Breakfast.

9: Kathleen McCooe Nilles ’89 with student Brigette Bernhardt ’19, the Ann and Jack McCooe Nursing Scholar, at the 2019 Annual Dean’s Dinner. 10: Victoria Tiase ’06 and Patricia Dykes ’04 at the 2019 Alumni Reunion.

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“ I am grateful to Columbia for a nursing education that provided a lasting skill set for my career in the challenges and rewards of community health. With appreciation for the program’s focus on the psychosocial aspects of health and disease, my work in home care nursing, childbirth education, and nursing in a high school health center has been a wonderful opportunity—complete with tremendous flexibility, as family life with my husband and two children evolved. “ Since retiring in 2007, I volunteer at an adult day care and continue to be thankful for the support, financial aid, and education that Columbia made possible in my life. Indeed, Columbia Nursing’s exceptional program transcends change and remains relevant every day! “ In giving back, my wish is that current and future students, now in expanded roles of advanced practice in patient care and clinical research, have an equally rich experience at Columbia Nursing.” — Margaret Moore Hazlett ’68

JÖRG ME YER

Why I 24

Columbia Nursing Fall/Winter 2019

For more information about giving to Columbia Nursing, visit nursing.columbia.edu/giving or contact Janice Grady, executive director of development and alumni relations, at 212-305-1088 or jar2272@cumc.columbia.edu.

Government and Private Funding for

Research and Training July 1, 2018â&#x20AC;&#x201C;June 30, 2019

G E T T Y IM A G E S

Principal Investigator: Suzanne Bakken, PhD, RN, FAAN Project Title: New York City Hispanic Dementia Caregiver Research Program (NHiRP) R01NR014430 (Multiple PI: Jose Luschinger, MD [Contact]) Program Funding Source: NIH-NINR Total Budget: $2,662,135 Total Project Dates: 6/1/2013 - 3/31/2019 Principal Investigator: Suzanne Bakken, PhD, RN, FAAN Project Title: Precision in Symptom Self-Management Center (PriSSM) P30NR016587 Program Funding Source: NIH-NINR Total Budget: $2,722,457 Total Project Dates: 8/16/2016 - 5/31/2021 Principal Investigator: Suzanne Bakken, PhD, RN, FAAN Project Title: Reducing Health Disparities Through Informatics (RHeaDI) T32NR007969 Program Funding Source: NIH-NINR Total Budget: $1,939,614 Total Project Dates: 7/1/2017 - 6/30/2022

Principal Investigator: Suzanne Bakken, PhD, RN, FAAN Project Title: iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) R01NR014853 Program Funding Source: NIH-NINR Total Budget: $1,988,000 Total Project Dates: 8/1/2014 - 5/31/2019 Principal Investigator: Melissa Beauchemin, PhD, RN Project Title: Implementation of CINV Guidelines in Pediatric Cancer Patients DSCN-18-068-01-SCN Program Funding Source: ACS Total Budget: $30,000 Total Project Dates: 7/1/2018 - 6/30/2020 Principal Investigator: Jean-Marie Bruzzese, PhD Project Title: A Pilot Study to Improve Sleep Quality in Urban High School Students with Asthma R21HD086448 Program Funding Source: NIH-NICHD Total Budget: $456,375 Total Project Dates: 9/25/2016 - 8/31/2019

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Government and Private Funding for Research and Training Principal Investigator: Jean-Marie Bruzzese, PhD Project Title: Translating an Evidence-Based Urban Asthma Program for Rural Adolescents: Testing Effectiveness & Cost-Effectiveness and Understanding Factors Associated with Implementation R01HL136753 Program Funding Source: NIH-NHLBI Total Budget: $3,620,591 Total Project Dates: 7/5/2017 - 6/30/2023 Principal Investigator: Jean-Marie Bruzzese, PhD Project Title: Multi-Component Technology Intervention for African American Emerging Adults R01HL133506 Program Funding Source: NIH-NHLBI (Wayne State University Subcontract) Total Budget: $165,081 Total Project Dates: 9/1/2016 - 6/30/2021 Principal Investigator: Jean-Marie Bruzzese, PhD Project Title: Peer-Administered Asthma Self-Management Intervention in Urban Middle Schools R01MD012225 Program Funding Source: NIH-NIMHD (Rhode Island Hospital Subcontract) Total Budget: $136,006 Total Project Dates: 9/25/2017 - 6/30/2022 Principal Investigator: Kenrick Dwain Cato, PhD, RN Project Title: Finding the Safer Way: Novel Interaction Design Approaches to Health IT Safety R01HS023708 Program Funding Source: AHRQ (University of Pittsburgh Subcontract) Total Budget: $29,042 Total Project Dates: 7/1/2015 - 4/30/2020 Principal Investigator: Kenrick Dwain Cato, PhD, RN Project Title: Communicating Narrative Concerns Entered by RNs (CONCERN) R01NR01694101 (Multiple PI: Sarah Collins, PhD, RN [Contact]) Program Funding Source: NIH-NINR Total Budget: $2,415,488 Total Project Dates: 5/1/2018 - 1/31/2022 Principal Investigator: Stephen Ferrara, DNP, RN Project Title: Collaborative Access for LGBT Adults (CALA) UD7HP29872 Program Funding Source: HRSA Total Budget: $488,062 Total Project Dates: 7/1/2018 - 6/30/2019

Columbia Nursing Fall/Winter 2019

Principal Investigator: Lorraine Frazier, PhD, RN, FAAN Project Title: Jonas Nursing and Veterans Healthcare at Columbia University JCHCU16-0569 Program Funding Source: Jewish Communal Fund/Jonas Nursing and Veterans Healthcare Total Budget: $11,082,858 Total Project Dates: 12/28/2017 - 12/27/2027 Principal Investigator: Lorraine Frazier, PhD, RN, FAAN Project Title: Ladies Christian Union (LCU) Fund for Womenâ&#x20AC;&#x2122;s Education LCUCU18-0083 Program Funding Source: LCU Total Budget: $16,000 Total Project Dates: 7/1/2018 - 6/30/2019 Principal Investigator: Lorraine Frazier, PhD, RN, FAAN Project Title: The Hyde and Watson Foundation Grant 2018 HYDECU18-0474 Program Funding Source: H&W Total Budget: $10,000 Total Project Dates: 9/1/2018 - 8/31/2019 Principal Investigator: Maureen George, PhD, RN Project Title: Self-Care Decision-Making: Feasibility of the BREATHE Asthma Intervention Trial R21NR016507 Program Funding Source: NIH-NINR Total Budget: $455,758 Total Project Dates: 9/26/2016 - 7/31/2019 Principal Investigator: Amanda Hessels, PhD, RN Project Title: Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes K01OH011186 Program Funding Source: CDC Total Budget: $324,000 Total Project Dates: 9/2/2016 - 8/31/2019 Principal Investigator: Amanda Hessels, PhD, RN Project Title: Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial R18HS026418 Program Funding Source: AHRQ Total Budget: $1,860,798 Total Project Dates: 3/1/2019 - 2/29/2024 Principal Investigator: Tonda Hughes, PhD, RN, FAAN Project Title: Impact of Supportive Policies on Minority Stress, Drinking, and Health Among Women R01AA013328 Program Funding Source: NIH-NIAAA (University of Illinois at Chicago Subcontract) Total Budget: $251,919 Total Project Dates: 2/1/2017 - 7/31/2021

Principal Investigator: Tonda Hughes, PhD, RN, FAAN Project Title: Sexual Orientation Differences: Prevalence and Correlates of Substance Use and Abuse R01DA036606 Program Funding Source: NIH-NIDA (Public Health Institute Subcontract) Total Budget: $137,725 Total Project Dates: 2/1/2017 - 8/31/2019 Principal Investigator: Tonda Hughes, PhD, RN, FAAN Project Title: Health, Stress, and Tobacco Use Disparities Among Sexual Minority Populations R01CA212517 Program Funding Source: NIH-NCI (University of Michigan Subcontract) Total Budget: $61,186 Total Project Dates: 6/16/2017 - 5/31/2020 Principal Investigator: Tonda Hughes, PhD, RN, FAAN Project Title: Sexual Orientation, Discrimination, and Health Disparities in DSM-5 Alcohol Use Disorder R01AA025684 Program Funding Source: NIH-NIAAA (University of Michigan Subcontract) Total Budget: $60,030 Total Project Dates: 4/1/2018 - 1/31/2019 Principal Investigator: Tonda Hughes, PhD, RN, FAAN Project Title: Role of Stress in Shaping Maternal, Infant, and Child Outcomes R01HD091405 Program Funding Source: NIH-NICHD (University of Utah Subcontract) Total Budget: $22,166 Total Project Dates: 9/14/2018 - 5/31/2021 Principal Investigator: Theresa Koleck, PhD, RN Project Title: Advancing Chronic Condition Symptom Cluster Science Through Use of Electronic Health Records and Data Science Techniques K99NR017651 Program Funding Source: NIH-NINR Total Budget: $180,235 Total Project Dates: 6/1/2018 - 3/31/2020 Principal Investigator: Elaine Larson, PhD, RN Project Title: Flu SAFE: Flu SMS Alerts to Freeze Exposure R01AI127812 (Multiple PI: Lisa Saiman, MD, MPH, Melissa Stockwell, MD, MPH [Contact]) Program Funding Source: NIH-NIAID Total Budget: $798,011 Total Project Dates: 9/1/2016 - 8/31/2020

Principal Investigator: Elaine Larson, PhD, RN Project Title: Nursing Intensity of Patient Care Needs and Rates of Healthcare-Associated Infections (NIC-HAI) R01HS024915 Program Funding Source: AHRQ Total Budget: $1,350,476 Total Project Dates: 9/1/2016 - 8/31/2020 Principal Investigator: Jacqueline Merrill, PhD, RN Project Title: A Longitudinal Network Study of Alzheimerâ&#x20AC;&#x2122;s and Dementia Care in Relation to Disparities in Access and Outcomes R56AG056347-01 (Multiple PI: Miriam Ryvicker, PhD [Contact]) Program Funding Source: NIH-NIA (VNSNY Subcontract) Total Budget: $190,963 Total Project Dates: 9/30/2017 - 8/31/2018 Principal Investigator: Allison Norful, PhD, RN Project Title: Optimizing the Use of Primary Care Provider Workforce During Chronic Disease Care: The Measurement and Impact of Provider Co-Management RFUCU18-1324 Program Funding Source: RFU Total Budget: $25,000 Total Project Dates: 7/1/2018 - 6/30/2020 Principal Investigator: Michelle Odlum, EdD, RN Project Title: Exploring HIV Risk Within the Context of Gender-Based Imbalances in a US Population of Racial and Ethnic Minority Women at Risk for HIV/AIDS P017002027 Program Funding Source: HPTN Total Budget: $94,692 Total Project Dates: 4/1/2017 - 9/30/2018 Principal Investigator: Lusine Poghosyan, PhD, RN Project Title: Further Psychometric Testing and Validation of the Errors of Care Omission Survey (EoCOS) R03HS024758 Program Funding Source: AHRQ Total Budget: $99,795 Total Project Dates: 7/1/2016 - 9/30/2018 Principal Investigator: Lusine Poghosyan, PhD, RN Project Title: Racial and Ethnic Disparities in Chronic Disease Outcomes and Nurse Practitioner Practice R01MD011514 Program Funding Source: NIH-NINR Total Budget: $2,558,012 Total Project Dates: 6/13/2017 - 1/31/2021 Principal Investigator: Lusine Poghosyan, PhD, RN Project Title: Nurse Practitioner Supply, Practice, and Economic Efficiency to Benefit the Underserved and Medicaid Patients R101016 Program Funding Source: NCSBN Total Budget: $256,416 Total Project Dates: 3/1/2018 - 3/01/2020

Fall/Winter 2019

Columbia Nursing 27

Government and Private Funding for Research and Training Principal Investigator: Lusine Poghosyan, PhD, RN Project Title: Social Networks in Medical Homes and Impact on Patient Care and Outcomes R01HS025937 Program Funding Source: AHRQ Total Budget: $2,123,805 Total Project Dates: 2/1/2019 - 1/31/2024

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: mLab App for Improving Uptake of Rapid HIV Self-Testing and Linking Youth to Care R01MH118151 Program Funding Source: NIH-NIMHD Total Budget: $4,090,639 Total Project Dates: 8/3/2018 - 5/31/2023

Principal Investigator: Tawandra Rowell-Cunsolo, PhD Project Title: Contextualizing and Responding to HIV Risk Behaviors Among Black Drug Offenders K01DA036411 Program Funding Source: NIH-NINR Total Budget: $703,574 Total Project Dates: 7/1/2013 - 12/31/2018

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: Mentoring and Research in Self-Management for Health Promotion and Disease Prevention K24NR018621 Program Funding Source: NIH-NINR Total Budget: $570,127 Total Project Dates: 4/17/2019 - 3/31/2024

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: Video Information Provider for HIV-Associated Non-AIDS (VIP-HANA) Symptoms R01NR015737 Program Funding Source: NIH-NINR Total Budget: $2,331,859 Total Project Dates: 7/16/2015 - 5/31/2020

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: Mobile Adaptation and Testing of a Uniquely Targeted HIV Intervention for Young Transgender Women R56MH113684 Program Funding Source: NIH-NINR (Brown University Subcontract) Total Budget: $58,321 Total Project Dates: 7/1/2018 - 6/30/2019

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: Video Information Provider for HIV-Associated Non-AIDS (VIP-HANA) Symptoms Alzheimerâ&#x20AC;&#x2122;s Supplement R01NR015737-04S1 Program Funding Source: NIH-NINR Total Budget: $404,982 Total Project Dates: 6/1/2018 - 5/31/2019

Principal Investigator: Jingjing Shang, PhD, RN Project Title: Infection Control in Home Care and Predictive Risk Modeling R01HS024723 Program Funding Source: AHRQ Total Budget: $1,391,760 Total Project Dates: 7/1/2016 - 4/30/2019

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: The Wise App Trial for Improving Health Outcomes in People Living with HIV/AIDS (PLWH) R01HS025071 Program Funding Source: AHRQ Total Budget: $1,989,445 Total Project Dates: 9/30/2016 - 9/29/2021

Principal Investigator: Jingjing Shang, PhD, RN Project Title: Infection Prevention in Home Health Care (InHOME) R01NR016865 Program Funding Source: NIH-NINR Total Budget: $2,534,014 Total Project Dates: 9/21/2017 - 6/30/2021

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: A Pragmatic Clinical Trial of MyPEEPS Mobile to Improve HIV Prevention Behaviors in Diverse Adolescent Men Who Have Sex with Men (MSM) U01MD011279 Program Funding Source: NIH-NIMHD Total Budget: $7,882,836 Total Project Dates: 9/1/2016 - 4/30/2021

Principal Investigator: Jingjing Shang, PhD, RN Project Title: Home Health Agencies in the Changing Policy Environment AHHQICU18-0122 Program Funding Source: AHHQI Total Budget: $149,983 Total Project Dates: 4/1/2018 - 9/30/2019

Principal Investigator: Rebecca Schnall, PhD, RN Project Title: A Pragmatic Clinical Trial of MyPEEPS Mobile to Improve HIV Prevention Behaviors in Diverse Adolescent Men Who Have Sex with Men (MSM) Diversity Supplement U01MD011280-02S1 Program Funding Source: NIH-NIMHD Total Budget: $79,593 Total Project Dates: 5/1/2018 - 4/30/2019

Columbia Nursing Fall/Winter 2019

Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Columbia University Future of Nursing Scholars (2nd Cohort: 2 Scholars) 72569 Program Funding Source: RWJF $100,000 Total Project Dates: 4/1/2015 - 8/31/2018

Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Columbia University Future of Nursing Scholars (3rd Cohort: 2 Scholars) 73510 Program Funding Source: RWJF Total Budget: $75,000 Total Project Dates: 4/15/2016 - 7/31/2019

Principal Investigator: Patricia Stone, PhD, RN, FAAN Project Title: Comparative and Cost-Effectiveness Research Training for Nurse Scientists T32NR014205 Program Funding Source: NIH-NINR Total Budget: $1,503,740 Total Project Dates: 7/1/2017 - 6/30/2023

Principal Investigator: Arlene Smaldone, PhD, RN Columbia University Future of Nursing Scholars (4th Cohort: 2 Scholars) 74336 Program Funding Source: RWJF Total Budget: $150,000 Total Project Dates: 4/15/2017 - 7/14/2020

Principal Investigator: Patricia Stone, PhD, RN, FAAN Project Title: Study of Infection Management and Palliative Care at End-of-Life (SIMP-EL) R01NR013687 Program Funding Source: NIH-NINR Total Budget: $2,759,942 Total Project Dates: 7/1/2012 - 3/31/2021

Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Columbia University Future of Nursing Scholars (5th Cohort: 2 Scholars) 75252 Program Funding Source: RWJF Total Budget: $150,000 Total Project Dates: 4/1/2018 - 7/31/2021

Principal Investigator: Patricia Stone, PhD, RN, FAAN Project Title: Study of Infection Management and Palliative Care at End-of-Life (SIMP-EL) Alzheimerâ&#x20AC;&#x2122;s Supplement R01NR013687-06S1 Program Funding Source: NIH-NINR Total Budget: $477,060 Total Project Dates: 9/13/2018 - 3/31/2019

Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Jonas Nurse Leaders and Veterans Scholar Program 2016 - 2018 JCNVHCU153329 Program Funding Source: Jonas Nursing and Veterans Healthcare Total Budget: $80,000 Total Project Dates: 6/1/2016 - 7/31/2018 Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Jonas Nurse Leaders and Veterans Scholar Program 2018 - 2020 JCNVHCU181060 Program Funding Source: Jonas Nursing and Veterans Healthcare Total Budget: $90,000 Total Project Dates: 8/1/2018 - 7/31/2020 Principal Investigator: Arlene Smaldone, PhD, RN Project Title: Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment R01NR017206 (Multiple PI: Nancy Green, MD [Contact]) Program Funding Source: NIH-NINR Total Budget: $2,938,465 Total Project Dates: 9/27/2017 - 6/30/2021 Principal Investigator: Samantha Stonbraker, PhD, RN Project Title: Information Visualizations to Facilitate Clinician-Patient Communication in HIV Care (Info Viz: HIV) K99NR017829 Program Funding Source: NIH-NINR Total Budget: $180,672 Total Project Dates: 9/1/2018 - 8/31/2020

Principal Investigator: Patricia Stone, PhD, RN, FAAN Project Title: Barriers and Facilitators for NHSN Adoption in Nursing Homes CDC200-2016-91952 Program Funding Source: CDC Total Budget: $371,995 Total Project Dates: 9/20/2016 - 9/19/2018 Principal Investigator: Patricia Stone, PhD, RN, FAAN Project Title: Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) P20NR018072 (Contact PI: Patricia Stone, PhD) Program Funding Source: NIH-NINR Total Budget: $2,039,992 Total Project Dates: 8/8/2018 - 5/31/2023 Principal Investigator: Cindy Veldhuis, PhD Project Title: Testing Associations Among Sexual Identity, Race/Ethnicity, Relationship Characteristics, and Hazardous Drinking F32AA025816 Program Funding Source: NIH-NIAAA Total Budget: $190,406 Total Project Dates: 9/1/2017 - 8/31/2020

Fall/Winter 2019

Columbia Nursing 29

Selected Faculty

Publications

JÖRG ME YER

Our faculty’s research continues to create new knowledge that advances health care. Listed are selected articles published by leading peer-reviewed publications. Adriana Arcia, PhD, assistant professor; Suzanne Bakken, PhD, Alumni Professor of Nursing, and professor of biomedical informatics; and Niurka Suero-Tejeda, MS, project director, were among

the authors of “Helping Hispanic Family Caregivers of Persons with Dementia ‘Get the Picture’ About Health Status Through Tailored Infographics,” published in The Gerontologist. Adriana Arcia, PhD, assistant professor, and Maureen George, PhD, associate professor, were

the authors of “Reference Range Number Line Format Preferred by Adults for Display of Asthma Control Status,” published in the Journal of Asthma. Adriana Arcia, PhD, assistant professor, and Samantha Stonbraker ’13 ’16, PhD, associate research scientist, were the authors of “Infor-

mation Needs and Information-Seeking Processes of Low-Income Pregnant Women in Relation to Digital Maternity Education Resources,” published in The Journal of Perinatal Education.

Columbia Nursing Fall/Winter 2019

Dawon Baik, PhD, postdoctoral research fellow, and Haomiao Jia, PhD, professor of biostatistics, were among the authors of

“Measuring Health Status and Symptom Burden Using a Web-Based mHealth Application in Patients with Heart Failure,” published in the European Journal of Cardiovascular Nursing. Suzanne Bakken, PhD, Alumni Professor of Nursing, and professor of biomedical informatics, and Rebecca Schnall ’09, PhD, Mary Dickey Lindsay Associate Professor of Disease Prevention and Health Promotion, were among

the authors of “Behavioral Interventions Using Consumer Information Technology as Tools to Advance Health Equity,” published in the American Journal of Public Health.

of Urban Adolescents,” published in the Journal of Urban Health. Billy Caceres, PhD, assistant professor, was among the authors of “Provider and LGBT Individuals’ Perspectives on LGBT Issues in Long-Term Care: A Systematic Review,” published in The Gerontologist. Billy Caceres, PhD, assistant professor; Kenrick Cato ’08 ’14, PhD, assistant professor; Kasey Jackman ’05 ’10 ’17, PhD, postdoctoral research fellow; and Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health, were among

the authors of “A Scoping Review of Sexual Minority Women’s Health in Latin America and the Caribbean,” published in the International Journal of Nursing Studies. Billy Caceres, PhD, assistant professor, and Kathleen Hickey, EdD, professor, were the

Jean-Marie Bruzzese, PhD, associate professor, and Lusine Poghosyan, PhD, Stone Foundation and Elise D. Fish Associate Professor of Nursing,

authors of “Examining Sleep Duration and Sleep Health among Sexual Minority and Heterosexual Adults: Findings from NHANES (2005-2014),” published in Behavioral Sleep Medicine.

were among the authors of “Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort

Billy Caceres, PhD, assistant professor; Kathleen Hickey, EdD, professor; and Tonda Hughes, PhD,

Henrik H. Bendixen Professor of International Nursing, and associate dean for global health,

were among the authors of “An Intersectional Approach to Examine Sleep Duration in Sexual Minority Adults in the United States: Findings from the Behavioral Risk Factor Surveillance System,” published in Sleep Health.

Satisfaction,” published in Nursing Economic$; “Missed Opportunities: The Development and Testing of Standard Precaution Case Vignettes,” published in the Journal of Infusion Nursing; and “Dissemination and Implementation Science for Infection Prevention: A Primer,” published in the American Journal of Infection Control.

Kasey Jackman ’05 ’10 ’17, PhD, postdoctoral research fellow, and Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health, were

among the authors of “Sexual and Gender Minority Health Research in Nursing,” published in Nursing Outlook. Ana Kelly, PhD, assistant professor, was the

Billy Caceres, PhD, assistant professor; Kathleen Hickey, EdD, professor; Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health; and Cindy Veldhuis, PhD, postdoctoral research fellow, were the authors of “Lifetime Trauma

Amanda Hessels, PhD, assistant professor; Ana Kelly, PhD, assistant professor; Bevin Cohen ’17, PhD, associate research scientist; and Elaine Larson, PhD, Anna C. Maxwell Professor of Nursing Research, and senior associate dean of scholarship and research, were the authors of

and Cardiometabolic Risk in Sexual Minority Women,” published in the Journal of Women’s Health.

“Impact of Infectious Exposures and Outbreaks on Nurse and Infection Preventionist Workload,” published in the American Journal of Infection Control.

Billy Caceres, PhD, assistant professor, and Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health, were among the

authors of “Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women,” published in the Journal of Cardiovascular Nursing. Billy Caceres, PhD, assistant professor; Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health; and Cindy Veldhuis, PhD, postdoctoral research fellow, were the authors

of “Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women,” published in Health Equity. Christian Cansino ’15 ’17, DNP, assistant professor, was among the authors of “Effects of

Midazolam on Postoperative Nausea and Vomiting and Discharge Times in Outpatients Undergoing Cancer-Related Surgery,” published in the AANA (American Association of Nurse Anesthetists) Journal. Amanda Hessels, PhD, assistant professor, was

among the authors of “Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events,” published in the Journal of Nursing Care Quality; “Administrative Supervisors and Nursing UnitBased Managers: Collaboration and Job

Judy Honig ’05, DNP, Dorothy M. Rogers Professor of Nursing, and senior associate dean of academic affairs and dean of students; Jennifer Dohrn ’85 ’05, DNP, associate professor; and Susan Doyle-Lindrud ’94 ’08, DNP, associate professor, and assistant dean of academic affairs,

were the authors of “Moving Towards Universal Health Coverage: Advanced Practice Nurse Competencies,” published in Revista Latino-americana de Enfermagem. Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health, was among the authors

of “Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their ‘Not Sure’ Counterparts,” published in LGBT Health; and “Predicting Cervical Cancer Screening Among Sexual Minority Women Using Classification and Regression Tree Analysis,” published in Preventive Medicine Reports. Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health; Cindy Veldhuis, PhD, postdoctoral research fellow; and Kelly Martin, MEd, project manager, were among the authors of

“Femininity, Masculinity, and Body Image in a Community-Based Sample of Lesbian and Bisexual Women,” published in Women & Health.

author of “Tuberculosis” in the Nursing Clinics of North America. Theresa Koleck, PhD, associate research scientist, and Suzanne Bakken, PhD, Alumni Professor of Nursing, and professor of biomedical informatics, were among the authors of

“Natural Language Processing of Symptoms Documented in Free-Text Narratives of Electronic Health Records: A Systematic Review,” published in the Journal of the American Medical Informatics Association. Kristine Kulage, MPH, director of the Office of Scholarship and Research Development; Elaine Larson, PhD, Anna C. Maxwell Professor of Nursing Research, and senior associate dean of scholarship and research; and Joshua Massei, MBA, research office coordinator, were

the authors of “NIH Funding Ranked ‘Per-Capita’: An Alternative Method for Assessing Research Productivity,” published in the Western Journal of Nursing Research. Kristine Kulage, MPH, director of the Office of Scholarship and Research Development, and Arlene Smaldone ’03, PhD, professor, and assistant dean of scholarship and research,

were among the authors of “How Has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-Analysis,” published in the Journal of Autism and Developmental Disorders. Allison LaCross ’12 ’14, DNP, assistant professor, and Arlene Smaldone ’03, PhD, professor, and assistant dean of scholarship and research, were among the authors of

“Ambivalence Toward Pregnancy as an Indicator for Contraceptive Nonuse: A Systematic Review and Meta-Analysis,” published in the Journal of Midwifery & Women’s Health.

Fall/Winter 2019

Columbia Nursing 31

Selected Faculty Publications Maichou Lor, PhD, postdoctoral research fellow; Suzanne Bakken, PhD, Alumni Professor of Nursing, and professor of biomedical informatics; and Theresa Koleck, PhD, associate research scientist, were the authors of “Information Visual-

izations of Symptom Information for Patients and Providers: A Systematic Review,” published in the Journal of the American Medical Informatics Association; and “Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension,” published in the Journal of Racial and Ethnic Health Disparities. Maribeth Massie ’98, PhD, assistant professor,

Arlene Smaldone ’03, PhD, professor, and assistant dean of scholarship and research,

was among the authors of “Greater Number of Perceived Barriers to Hydroxyurea Associated with Poorer Health-Related Quality of Life in Youth with Sickle Cell Disease,” published in Pediatric Blood and Cancer. Arlene Smaldone ’03, PhD, professor, and assistant dean of scholarship and research; Kasey Jackman ’05 ’10 ’17, PhD, postdoctoral research fellow; Judith Kelson, MSW, assistant program director, PhD program; and Kyungmi Woo, PhD, postdoctoral research fellow,

was among the authors of “Role of Alveolar-Arterial Gradient in Partial Pressure of Oxygen and PaO2/Fraction of Inspired Oxygen Ratio Measurements in Assessment of Pulmonary Dysfunction,” published in the AANA (American Association of Nurse Anesthetists) Journal.

were among the authors of “Dissemination of PhD Dissertation Research by Dissertation Format: A Retrospective Cohort Study,” published in the Journal of Nursing Scholarship.

Allison Norful ’17, PhD, associate research scientist, and Lusine Poghosyan, PhD, Stone Foundation and Elise D. Fish Associate Professor,

authors of “Perceived Impact of StateMandated Reporting on Infection Prevention and Control Departments,” published in the American Journal of Infection Control

were among the authors of “Development and Psychometric Testing of the Provider Co-Management Index: Measuring Nurse Practitioner-Physician Co-Management,” published in the Journal of Nursing Measurement; and “Nurse PractitionerPhysician Co-Management of Patients in Primary Care,” published in Policy, Politics, & Nursing Practice.

Patricia Stone, PhD, Centennial Professor of Health Policy, was among the

Patricia Stone, PhD, Centennial Professor of Health Policy, and Mansi Agarwal, PhD, project director, were among the authors

of “Integration of Palliative Care and Infection Management at the End of Life in U.S. Nursing Homes,” published in Journal of Pain and Symptom Management.

Lusine Poghosyan, PhD, Stone Foundation and Elise D. Fish Associate Professor, and Cilgy Abraham, PhD student, were among the

Carolyn Sun ’15, PhD, associate research scientist, was among the authors of “Using

authors of “The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid,” published in the Journal of Nursing Regulation.

a Delphi Survey to Develop Clinical Nursing Research Priorities Among Nursing Management,” published in The Journal of Nursing Administration.

Lusine Poghosyan, PhD, Stone Foundation and Elise D. Fish Associate Professor, and Affan Ghaffari, PhD, research coordinator, were among

Maxim Topaz, PhD, Elizabeth Standish Gill Associate Professor of Nursing, was among

the authors of “Nurse Practitioner Primary Care Organizational Climate Questionnaire: Item Response Theory and Differential Item Functioning,” published in the Journal of Clinical Nursing.

Columbia Nursing Fall/Winter 2019

the authors of “Mining Fall-Related Information in Clinical Notes: Comparison of Rule-Based and Novel Word EmbeddingBased Machine Learning Approaches,” published in the Journal of Biomedical Informatics; “Nurses ‘Seeing Forest for

the Trees’ in the Age of Machine Learning: Using Nursing Knowledge to Improve Relevance and Performance,” published in CIN: Computers, Informatics, Nursing; “Mining Social Media Data to Assess the Risk of Skin and Soft Tissue Infections from Allergen Immunotherapy,” published in the Journal of Allergy and Clinical Immunology; “Patient-Centered Care via Health Information Technology: A Qualitative Study with Experts from Israel and the U.S.,” published in Informatics for Health and Social Care; and “Identifying Patients at Highest-Risk: the Best Timing to Apply a Readmission Model,” published in BMC Medical Informatics and Decision Making. Cindy Veldhuis, PhD, postdoctoral research fellow; Jean-Marie Bruzzese, PhD, associate professor; Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health; and Maureen George, PhD, associate professor,

were authors of “Asthma Status and Risks Among Lesbian, Gay, and Bisexual Adults in the United States: A Scoping Review,” published in Annals of Allergy, Asthma & Immunology. Cindy Veldhuis, PhD, postdoctoral research fellow, and Tonda Hughes, PhD, Henrik H. Bendixen Professor of International Nursing, and associate dean for global health, were

among the authors of “Sexual Minority Women’s and Gender-Diverse Individuals’ Hope and Empowerment Responses to the 2016 Presidential Election,” published in the Journal of GLBT Family Studies; and “Barriers to Contraceptive Use among Adolescents in Two Semi-Rural Nicaraguan Communities,” published in the International Journal of Adolescent Medicine and Health. Katherine Zheng, PhD student; Jean-Marie Bruzzese, PhD, associate professor; and Arlene Smaldone ’03, PhD, professor, and assistant dean of scholarship and research, were the authors

of “Illness Acceptance in Adolescents: A Concept Analysis,” published in Nursing Forum.

“ Columbia Nursing’s Annual Fund gave me the opportunity to experience a global clinical placement in The Gambia, West Africa. Four of us were lucky enough to be the first ever to volunteer as nursing students in the only tertiary teaching and referral hospital in the country. While providing care in a limitedresource setting, I learned how I could truly make a difference. My Global Fellowship was the highlight of my nursing education at Columbia and will inform my practice, wherever I serve. I am profoundly grateful.”

Make your gift to the Annual Fund today!

“— Sumiyah Syed-Uddin ’19, MSN; DNP student, pediatric nurse practitioner specialty

HELP BUILD THE

FUTURE OF NURSING Scholarship Fund

Dean’s Discretionary Fund

To make your tax-deductible contribution, send a check payable to Columbia University School of Nursing or donate online at nursing.columbia.edu/giving.

For more information, contact Janine Handfus, associate director, Annual Fund, at 212-305-0079 or jh2526@cumc.columbia.edu.

Global Fellows Fund

560 West 168th Street, MC 6 New York, NY 10032

EVENTS NOVEMBER 2019

14 16

MEET THE DEAN San Francisco, CA MEET THE DEAN Los Angeles, CA

MARCH 2020

3 4 7

ANNA C. MAXWELL BIRTHDAY CELEBRATION Columbia Nursing ANNUAL DEAN’S DINNER: CELEBRATION OF LEADERSHIP GIVING Columbia Nursing MEET THE DEAN New Canaan, CT

Visit nursing.columbia.edu/alumni to learn more about our upcoming events.

APRIL 2020

9 18 30

MEET THE DEAN Boston, MA MEET THE DEAN Savannah, GA ALUMNI AWARDS DINNER Columbia Nursing

MAY 2020

ALUMNI REUNION Daytime Reunion Programming Columbia Nursing Happy Hour for Recent Alumni Location TBD

COLUMBIA NURSING GRADUATION CEREMONY

MAY 29 – JUNE 2, 2020 ALUMNI RECEPTION DURING ACNM ANNUAL MEETING Austin, TX

SEPTEMBER 2020

MEET THE DEAN Raleigh, NC

SEPTEMBER 29 – OCTOBER 6, 2020 COLUMBIA NURSING 2020 ALUMNI TRIP TO LONDON London, UK

Columbia Nursing Fall 2019

Articles inside

The Chief Nursing Officer: A Critical System-Level Role for Nursing

Palliative Care: A Whole-Picture Perspective

The NP Will See You Now