NURSING without The intersection of initiatives is leading the future of nursing.
WALLS
Nursing Rounds
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Opening Access for the Underserved $1M campaign gift supports rural nurse practitioners, telehealth
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Improving Health, Removing Barriers Two faculty garner 2014 Robert Wood Johnson Foundation Appointments
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Real-World Preparation
Nursing Without Walls 4 Unique Residency, Unequaled Value The UAB School of Nursing is teaming with the Birmingham VAMC as one of four sites for a Veterans Health Administration-sponsored residency for mental health nurse practitioners
Departments
Leading the nation using interprofessional simulation in education
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Leading Transitional Care $1.5M NEPQR grant supports new heart failure clinic
UAB NURSING MAGAZINE STAFF
24 The Assessment
36 The Review: Leadership
A roundup of UAB School of Nursing news and notes
Books that are shaping the careers of UAB School of Nursing alumni, faculty and graduate students
26 Five Questions With... Jim Raper on his personal revelation in the book Positive
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EDITOR Jennifer Lollar CREATIVE DIRECTOR Meredith Robinson WRITERS Cary Estes, Catie Etka, Nancy Mann Jackson, Jennifer Lollar, Jo Lynn Orr, Gail Allyn Short, Anita Smith PHOTOGRAPHERS Caleb Chancey, Rob Culpepper, Nik Layman, Charlie Prince, Steve Wood
39 In Their Own Words Real-life experiences as told by the clinicians, researchers, faculty and students who lived them
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ew high-stakes benchmarks set for population health in this era of the Patient Protection and Affordable Care Act (ACA) position nursing to improve health outcomes across entire populations, now and into the future. This issue, “Nursing Without Walls,” highlights UAB Nursing’s leadership, discovery and innovation to educate and deliver better care to populations across the health continuum. The initiatives led by our students, faculty, alumni and community board not only raise the benchmarks for improving population health, but also lead discovery that translates and sets higher standards of seamless care delivery for people everywhere. Our partnership initiatives span beyond the traditional “walls” or boundaries of education, research and practice to intersect and reach students, alumni and populations everywhere. The UAB School of Nursing tackles the most complex population health issues through education, discovery, and the translation of clinical knowledge into practice. We incorporate the social determinants of health in our paradigm to reduce disparities and inequities. We are “Nursing Without Walls,” generating knowledge in professional and advanced practice nursing that will transform health and change the world. You will read the stories of our students, faculty and graduates who are transforming health for the most vulnerable, underserved populations: Veterans, infants, frail elderly, and the chronically ill with HIV/AIDS, congestive heart failure, diabetes, cancer and at the end of life. UAB School of Nursing faculty are on the leading edge of discovery in research, education and practice, weaving palliative care, tailored clinical interventions, patent and technology development, and new interprofessional models of education and care delivery into the future of nursing and health care—aimed at the central purpose of improving the health of individuals, families and populations here in the Deep South and beyond. Our students, faculty and alumni lead worldwide, pushing the boundaries in the classroom, research, practice, across health disciplines, organizations and communities. Our alumni excel in their accomplishments and recognition, and our committed community acknowledges our achievements through their long-term investment in our future.
I hope you share my pride as you read about the people and programs in the UAB School of Nursing demonstrating how our innovative leadership transforms the health of populations. And speaking of the future, we have high hopes. With the proposal for a School of Nursing building transformation and expansion to accommodate our remarkable growth, moving forward we believe openness, light, innovative learning and new knowledge will magnify in this proposed new space. We continue to recruit the best and brightest faculty and students, who together with our alumni excel at breakthrough developments in nursing education and health care. The UAB School of Nursing, its people and programs promise to be “Trailblazers” in shaping health and health care, leading nursing’s contribution to a better, more comprehensive system of care for all.
Letter from the Dean
Dean Doreen C. Harper, PhD, RN, FAAN Fay B. Ireland Endowed Chair in Nursing
"The initiatives led by our students, faculty, alumni and community board not only raise the benchmarks for improving population health, but also lead discovery that translates and sets higher standards of seamless care delivery for people everywhere."
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Nursing
Without Walls :
Partnerships direct care to populations in need
Nursing without walls—delivering quality care to populations how, when and where they need, and caring for their unique needs without traditional encumbrances—has become the essence of nursing that is practiced, taught and studied at the UAB School of Nursing.
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he strategic alignment with UAB’s premier academic medical center, as well as with other partners, has helped make the School an internationally recognized leader in building knowledge, access and capacity, as well as in producing leaders who shape coordinated, proactive and superior patient care.
Key to the nursing without walls concept in the School is its focus on population-based care—targeting specific populations of people and then developing, implementing and evaluating interventions to improve the health of that population with innovation and efficiency consistent with seamless care across the continuum. Creating programs to better care for Veterans, taking nursing care to underserved communities through nurse-managed clinics and telehealth, establishing policy to influence nursing practice, creating more accessible health information to heighten individuals’ quality of life or their understanding of their health, giving undergraduate students community-based research opportunities… all are unencumbered by traditional silos and encompass “Nursing Without Walls” and population-based care, and are the future of health care. And who better to lead health care into the future and everything these concepts embody than nurses—the only profession practicing every virtue these hold dear—healing, supporting, listening, discovering and teaching.
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Advanced practice nurses will be called upon to assume leadership roles and to lead health care teams. A residency allows them to be
immersed in teams for a year and see how it all works.” -Dr. Teena McGuinness WRITTEN BY NANCY MANN JACKSON // PHOTOGRAPHY BY ROB CULPEPPER
A lengthy residency program has long been the standard rite of passage for medical school graduates prior to entering clinical practice. In contrast, nurses have traditionally left school and gone straight to work in a clinical setting. But in recent years, growing numbers of nursing schools and hospitals have partnered to offer nurse practitioner residency programs, allowing newly trained nurse practitioners to experience the mentoring and additional training that come with an environment blending on-the-job experience with an educational setting.
Unique residency, unequaled value The UAB School of Nursing has started a new graduate residency in partnership with the Birmingham Veterans Affairs Medical Center for mental health nurse practitioners. It is designed to put more nurse practitioners into the VA pipeline to address the mental health needs of a growing Veteran population.
One of only four sites in the country to receive VA funding for a Mental Health Nurse Practitioner Residency Program, UAB launched its program in fall 2013 with a full complement of three residents. The program offers a 12-month paid residency within the Birmingham VAMC for recent nurse practitioner graduates who have already passed their national certification exams. With the new mental health nurse practitioner residency at the Birmingham VAMC and the recent award of the VANAP-GE (see sidebar, p.9), UAB is providing a range of opportunities for recent nurse practitioner graduates to continue their training in a paid professional setting, preparing them for future success on the job, offering a pathway to the DNP degree and improving care for the patients they will go on to serve.
Growth of Graduate Residency Programs The Affordable Care Act places great importance on health care teams, and providing residency programs for nurses supports that value, said Doreen C. Harper, PhD, RN, FAAN, Dean and Fay B. Ireland Endowed Chair in the UAB School of Nursing. For instance, nurse practitioner residents work closely with pharmacists, board-certified physicians and other nurses and nurse practitioners, learning the value of the team approach to health care and their roles as team members. “Nurse practitioner residencies are becoming more common because of the complexity of care, particularly with the growing number of people with chronic illnesses and multiple co-morbidities,” said Teena McGuinness, PhD, RN, FAAN, Co-Director of the Mental Health Nurse Practitioner Residency Program. “Advanced practice nurses will be called upon to assume leadership roles and to lead health care teams. A residency allows them to be immersed in teams for a year and see how it all works.” Nurse practitioner residency programs also help ease the transition for new nurse practitioners from the classroom to the clinical setting while offering a platform for leadership and expert practice through DNP preparation. Across the country, graduate nurse practitioner residency
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“New nurse practitioners can improve skills and development while being mentored by experienced mental health nurse practitioners, psychiatrists and other mental health providers.” -Dr. Teena McGuinness
NP residents Kara Tucker and Jessica Waldrop assess patients individually and through group therapy at the Birmingham VAMC.
programs are becoming a sought-after way for nurses to start their careers in rich learning environments with ongoing support from both clinicians and faculty members. “These programs allow nurses not to just be thrown into the complexity of their jobs, but to receive a significant amount of mentoring, training and professional socialization,” McGuinness said.
with the Birmingham VAMC and to better prepare nurse practitioners to meet the challenging psychological needs of America’s Veterans.
Mental Health Nurse Practitioner Residency
“UAB loves America’s Veterans,” McGuinness said. “We really have a heart for all Veterans, and because some Veterans have some very complex mental health and chronic care issues, this program allows us to prepare nurse practitioners to uniquely serve their health needs.”
UAB’s selection as one of the four sites for a Veterans Health Administration-sponsored residency for mental health nurse practitioners allows the UAB School of Nursing to expand a longtime partnership
The School of Nursing’s ongoing partnership with the Birmingham VAMC played a role in the site’s selection, said Cynthia Selleck, PhD, RN, FNP, the School’s Associate Dean for Clinical and GlobFALL 2014 / UAB NURSING
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Below (left to right): NP resident Kara Tucker, Dr. Teena McGuinness and NP resident Jessica Waldrop
Kara Tucker making rounds at the Birmingham VAMC
McGuinness said. “When they complete the residency they can hit the ground running or as part of the residency enter the DNP program.”
al Partnerships. Since 2008, the two institutions have worked together on several key projects, including the VA Nursing Academy Parternship, which teams VA Medical Centers with accredited schools of nursing with the goal of providing compassionate, highly educated nurses to meet the health care needs of America’s heroes. The Mental Health Nurse Practitioner Residency Program, created by a three-year pilot grant from the Veterans Health Administration Office of Academic Affiliation to the Birmingham VAMC, “allows smooth assimilation to the nurse practitioner role,” McGuinness said. “New nurse practitioners can improve skills and development while being mentored by experienced mental health nurse practitioners, psychiatrists, and other mental health providers, which is similar to the role of the one-year required physician psychiatry residency.” The program gives residents the opportunity to rotate through nine specialty areas, including programs for post-traumatic stress disorder, substance abuse recovery, and a team that works with seriously mentally ill Veterans in the community, McGuinness said. In addition to working full-time in a clinical mental health setting, residents spend time in classrooms twice weekly with psychiatry physician residents and psychology interns and meet weekly with program directors for ongoing support. “Residents get to see how mental health care teams work, and decide whether they want to commit to a career at the VA,” 8
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Not only does the residency program boost the confidence of mental health nurse practitioners and prepare them to transition to permanent employment as experienced professionals, but it also increases awareness of the nurse practitioner role to all professionals in the hospital setting. “Many health care providers, including other mental health disciplines, are not familiar with and do not fully understand the role of mental health nurse practitioners,” McGuinness said. “This program allows for mentoring from dedicated clinicians who have interest in, patience with, and understanding of the mental health nurse practitioner role.”
We spend a lot of time on military culture and embrace all eras of military service so residents know how to care for each Veteran.” -Dr. Teena McGuinness The mental health nurse practitioner residency program is also important to the Veteran community as well as the health care community. Because many Veterans have a wide range of mental health needs, the program offers mental health nurse practitioners an opportunity to learn how to serve patients with a variety of needs. And part of the residency involves education about the various cultures of each era of Veterans. “World War II Veterans had a completely different experience from Vietnam Veterans,” McGuinness said. “We spend a lot of time on military culture and embrace all eras of military service so residents know how to care for each Veteran.”
Dr. Susanne Fogger
New Wounds, New Approach
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he UAB School of Nursing and Birmingham VA Medical Center are again expanding their 43-year-old partnership and the focus on Veterans’ mental health needs. Created with a five-year grant from the Veterans Health Administration to the Birmingham VA Medical Center, the two will partner to execute the VA Nursing Academic Partnerships in Graduate Education (VANAP-GE)—the only one of its kind in the country—and will put 48 new psychiatric-mental health nurse practitioners into the VA workforce. “Over the past 12 years, our nation’s servicemen and women have been fighting a global war on terror which has produced a new set of wounds,” said UAB School of Nursing Program Director Susanne Fogger, DNP, CRNP, PMHNP-BC. “In previous wars hallmark injuries involved penetrating trauma, but this war has resulted in a disproportionate number of wounds to our Veterans’ mental health.”
The partnership will produce master’s-prepared mental health nurse practitioners who will have spent the majority of their clinical experiences at the Birmingham VA Medical Center, Fogger said. Upon completing their degree, students will be encouraged to complete the mental health nurse practitioner residency and the DNP degree. There are several innovative features of the program, including hands-on learning in integrated behavioral care within community-based outpatient clinics and learning how military culture impacts Veterans’ mental and overall health. Veteran-centric content developed through the VANAP-GE partnership will be incorporated into the curriculum to highlight the complete health needs of Veterans. “A VA military cultural competency course via the Center for Deployment Psychology will introduce students to military culture and basic terminology,” Fogger said. “Additionally, a once-per-month book club will focus on the experience of combat Veterans and
WRITTEN BY JENNIFER LOLLAR
includes Unbroken and We Were Soldiers Once. A series of documentaries also will be used that focus on eras of service, including Korea, Vietnam and Desert Storm, to contribute to understanding military culture and the unique health challenges faced by Veterans from each period.” This partnership has the potential to further transform advanced practice nursing education and practice and serve as a model for our nation, Fogger added. Fogger said nurse practitioner students also will be educated to understand stressors Veterans face, as well as address and treat emerging symptoms, including mental illness, substance misuse, suicidal ideation, physical and emotional pain, coupled with chronic illness. “And the result will be exceptionally educated advanced practice nurses who understand military culture, the complete health needs of Veterans and their families, and their frequently encountered psychiatric issues,” she concluded.
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Resources
Pam Carver and students in the School's telehealth center
Through this partnership, we hope to make a larger impact, statewide, and help UAB recruit and prepare more nurse practitioners to care for this vulnerable group of citizens." -Charles W. Daniel
Opening Access for the Underserved WRITTEN BY ANITA SMITH // PHOTOGRAPHY BY CALEB CHANCEY
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sing a four-year, $1 million gift from The Daniel Foundation of Alabama, the UAB School of Nursing is creating a far-reaching program designed to open up more health care access in medically underserved rural Alabama. Alabama has 62 of 67 counties with a shortage of primary care providers, impacting more than 1.6 million people. Many of them suffer from untreated— often undiagnosed—acute and chronic health problems, including diabetes, obesity, high blood pressure, cardiovascular diseases and cancers. This initiative, the Graduate Nursing Education Primary Care Scholars Program (GNEPCS), focuses on educating more advanced practice nurses to work in underserved areas, and on building networks connecting existing Alabama rural health care providers with one another and UAB—to reach more Alabamians needing primary care. 10
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Pam Carver, MSN, CRNP, is the GNEPCS Program Director. Among her initial tasks is identifying up to three hub sites in rural Alabama. These will be clinical training sites where faculty and students will link to nurse practitioners in rural areas. Participating students, known as GNEPC Scholars, will be studying at the graduate level and practicing at these sites to become advanced practice nurses. Some program activities will take place in clinical hubs; others will be based in the School, including dispensing vital health information through a telehealth coaching center staffed by faculty and experienced registered nurses enrolled in advanced nurse practitioner education at UAB. This intensifies the School’s already existing programs that recruit students from Alabama’s medically underserved areas and other initiatives funded by federal grants from the Health Resources and Services Administration (HRSA), including a grant that created
statewide Area Health Education Centers to recruit, support and retain health care professionals in these underserved areas. A central theme driving GNEPCS is generating and sharing new knowledge. GNEPCS is structured to produce new curricula for teaching students, develop best practice models, and establish an annual summit for health care providers across the state to learn and share approaches for helping the medically underserved. GNEPCS has several overarching goals, such as better access to care for acute and chronic health problems, as well as life-threatening emergencies; and for individuals to obtain knowledge and motivation to help increase self-care for their health and well-being. According to Daniel Foundation Chairman, Charles W. Daniel, the Foundation Board is extremely optimistic about this gift and what it can mean for the health of rural Alabamians. “Through this partnership, we hope to make a larger impact, statewide, and help UAB recruit and prepare more nurse practitioners to care for this vulnerable group of citizens.”
Research
Cancer Resources at Your Fingertips
App gives hope to patients by providing them with a feeling of control
WRITTEN BY JENNIFER LOLLAR AND TYLER GREER PHOTOGRAPHY BY ROB CULPEPPER
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t has not taken Assistant Professor Deborah Walker, DNP, CRNP, AOCN, long to prepare her recently launched cancer resources smart phone app to go beyond Birmingham or cancer. In early 2014 Walker, an oncology nurse practitioner, along with an interprofessional team of UAB faculty, staff and students, introduced a free, downloadable application they created to help health care providers and breast cancer patients identify resources for people in North Central Alabama. “A good number of the resources are not breast cancer-specific and go across many different cancers, including support groups, wig shops, prosthetics shops, and learning centers that accept children with or recovering from cancer,” Walker said. Funding and support came from the Women’s Breast Health Fund of the Community Foundation of Greater Birmingham as part of an effort to improve the quality of life of breast cancer survivors and their loved ones. Now Walker is preparing to extend the app to include other counties in Alabama and beyond. She has worked with the UAB
Research Foundation since the app’s initial launch to start a company, ResourceFull™, to expand its reach. “We are looking at geographic expansion and working with other patient populations, specifically with faculty here at the School, whose research and service touch many other diseases and conditions and whose patients could benefit from easily accessible information,” she said. “In the end I hope the app provides patients with a feeling of control over their circumstance.” Other UAB staff members involved in the creation of the app include Larry Owen, Senior Systems Analyst and Director of the Software Engineering and Prototyping Lab in the College of Arts and Sciences; and Matthew Jennings, Instructional Design Specialist in the School of Nursing. Students have also worked on the project, including Jamal Harris, a computer science major and developer in the Software Engineering and Prototyping Lab, and Amber Hardeman, a graduate student in the School of Public Health.
designed by Zee Que | designbolts.com
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The American Cancer Society estimated 3,720 new breast cancer cases were diagnosed in Alabama in 2013, with an incidence of 119.4 per 100,000 people.
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ACS estimates there will be nearly 1.7 million new cancer cases diagnosed nationally in 2014. And, all of these patients will need reliable resources that can positively impact their quality of life.
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The app allows users to search individually by service, county or target audience, or search all three categories at once.
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Review more than 500 resources at once and save them to a favorites list within the app. You can also email or text them.
“These collaborations enhanced the team building and knowledge development associated with this innovative digital technology,” Walker added.
To download visit cancerresources-al.org
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Leadership
Improving Health, Removing Barriers
Two faculty garner 2014 Robert Wood Johnson Foundation Appointments WRITTEN BY JENNIFER LOLLAR // PHOTOGRAPHY BY ROB CULPEPPER
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wo UAB School of Nursing faculty members have been selected by the Robert Wood Johnson Foundation as 2014 Scholars and Fellows. C. Ann Gakumo, PhD, RN, has been named an RWJF Nurse Faculty Scholar and Joy P. Deupree, PhD, MSN, APRNBC, has been named an RWJF Executive Nurse Fellow.
Impacting Health Literacy in HIV My goal is that this patient-centered intervention be effective and readily implemented and disseminated across health care settings...” - Dr. Ann Gakumo
Ann Gakumo was working as a critical care nurse in 2005 when she attended the National Coalition of Ethnic Minority Nurses Association’s first national conference, Creating Research Careers: The Beginning. “The idea of becoming a nurse scientist sparked my interest and I learned about the role I could have in an increasingly diverse country,” she said. Gakumo earned her PhD from the UAB School of Nursing in 2009, focusing her dissertation on the sexual health of young women at risk for HIV. However, through her practice and service she saw the devastating effects of HIV in the African-American community. She has since transitioned to health literacy and chronic disease management among those living with HIV. “For several years I cared for the critically ill with complex needs in a medical intensive care unit,” she said. “Many struggled with poor health literacy and verbalized concerns on how to manage their health once they were discharged.” As part of the three-year RWJF Nurse Faculty Scholars program, Gakumo will lead a three-phase foundational research study, Managing Health Outcomes By Interventions in Literacy Effectiveness (MOBILE), a peer support and text/graphic messaging intervention to promote medication adherence in low-literate, older African Americans with HIV. “Research shows greater percentages of minorities and older adults have limited health literacy, which has been associated with non-adherence to medications, treatment and care in people living with HIV,” she said. “Advances in antiretroviral therapy have made HIV a chronic, manageable condition. More effective strategies improving medication adherence and helping patients stay engaged in their care can lead to long, healthy lives.” As part of the program, Gakumo has a senior scientist and leader in the School of Nursing as a primary nursing mentor, Karen Meneses, PhD, FAAN, Professor and Associate Dean for Research. Meneses’ patient-directed, nurse-led quality of life Breast Cancer Education Intervention is recognized as a national model of survivorship education.
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My ultimate goal is to decrease practice barriers for nurse practitioners in Alabama and promote a culture of interprofessional practice and collegiality among nurse practitioners and physicians.” - Dr. Joy Deupree
Dr. Ann Gakumo
Dr. Joy Deupree
Michael Mugavero, MD, MHSc, Director of the UAB Center for AIDS Research Clinical Core, will be her research mentor. “My ultimate goal is to decrease practice barriers for nurse practitioners in Alabama and promote a culture of interprofessional practice and collegiality among nurse practitioners and physicians,” she said.
Gakumo said she hopes the intervention is successful and can impact patients outside UAB’s 1917 Clinic, from where study participants will be recruited. “My goal is that this patient-centered intervention be effective and readily implemented and disseminated across health care settings, especially in rural areas without immediate access to comprehensive care and health services.”
Improving health literacy, removing practice barriers Joy Deupree’s passion for improving access for those in rural, underserved areas has taken her from patient care to working with the Alabama legislature to pass legislation expanding the role of nurse practitioners, both of which drive her two Fellowship projects. Deupree is senior advisor for policy for the Nurse Practitioner Alliance of Alabama, which represents more than 3,000 Certified Registered Nurse Practitioners. Deupree and five colleagues established NPAA in 2006 to spearhead efforts to reduce practice barriers for advanced prac-
tice nurses in the state. She was president of NPAA from 2012-2013, championing the passage of a bill improving scope of practice. “Until this legislation was passed, NPs could not treat patients’ pain needs, leaving them to suffer, or wait months to see a physician,” she said. “For those in rural areas the problem was compounded by the distance some would have to travel to get a prescription.” Deupree said although 19 states and Washington, D.C., have independent practice for nurse practitioners, there is still work to be done. To support health care expansion over the next decade there will have to be continued growth and policy changes regarding scope of practice. Deupree said her time as a RWJF Executive Nurse Fellow and her project goals will give her more tools to build upon what has already been accomplished.
Deupree also is staying true to her early roots of helping underserved populations. In 2011 she established the Alliance of International Nurses for Improved Health Literacy. “Nurses have the most potential to impact the health literacy of patients because they are with patients longer than most other providers,” she said. While Alabama has some challenging health literacy needs, the need also is great on the national level. In her second Fellowship project Deupree will work with national nursing and health literacy leaders to better train nursing students as well as practicing nurses on the importance of health literacy. “Too often health care professionals provide patients with written information. Most do not realize how many patients read at or below a fifth grade level, which puts them at great risk for non-compliance. I hope to change that.”
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Leadership
Raising Suicide Awareness WRITTEN BY JO LYNN ORR // PHOTOGRAPHY BY ROB CULPEPPER
Dr. Summer Langston and Cassie Cobb
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he suicide rate among both male and female U.S. Veterans is soaring, according to recent reports. That trend, coupled with the personal experiences of their colleagues, convinced members of the UAB School of Nursing’s Student Nurses Association to take a proactive role in raising awareness of this growing national issue.
The UABSNA students brought attention to the suicide issue by presenting a resolution at the April 2014 National Student Nurses Association (NSNA) convention, in Nashville. “Our goal was to bring awareness to this very taboo subject and be a voice for America’s heroes. Our resolution advocated for an increased awareness of the suicide prevention resources available for Veterans and their families. The resolution passed with a 99 percent vote, the highest out of more than 60 resolutions that were presented,” said Selena DaCosta, RN, former UABSNA board member and current graduate advisor to the UAB Student Nurses Association.
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“Two of us have been personally affected by suicide,” said Cassie Cobb, RN, who graduated from the School of Nursing in April and now works in one of UAB Hospital’s intensive care units. “In my case, my grandfather, a World War II Veteran, took his own life after learning he had cancer. Another SNA board member actually walked in on her Veteran father who had a gun in his hand. Fortunately, she was able to talk him out of using it on himself. “I wanted to let people know about the resources that are out there,” Cobb continued, “because in my family we didn’t know the signs to look for and didn’t realize what was happening.”
National SNA members learned about suicide-prevention resources available to Veterans and their families based upon this advocacy by the UABSNA leaders. “Several Veterans were at the convention and they came up to us afterwards to share their enthusiasm for the resolution,” Cobb said. Before the UABSNA board members actually began drafting the resolution they put in long hours of research and preparation. They also sought the advice and support of their faculty advisor, Summer Langston, DNP, Assistant Professor of Nursing, and faculty member
Randy Moore, DNP, who is himself a Veteran and an Assistant Professor of Nursing. Moore also works with the School of Nursing’s VA Nursing Academy Partnership, which was established in 2009 in conjunction with the Birmingham VA Medical Center. He said some of the SNA board members who worked on the resolution were members of the Academy or had taken a VA elective that’s open to all School of Nursing students, thus giving them a deeper insight into Veteran's issues. He also credits the vision and collaboration between the Birmingham VA Medical Center senior nursing leadership, including Associate Director and BVAMC CNO Cynthia Cleveland, DNP, RN; VANA Co-Program Director Kim Froelich, PhD, RN; and UAB School of Nursing Dean Doreen Harper, PhD, RN, FAAN, with continuing “to produce viable, real-world pertinent outcomes related to the care of Veterans.” According to Moore, the students felt that what they had learned about the care of Veterans and their families might not be penetrating other schools of nursing as deeply as what they had been exposed to at UAB.
Cassie Cobb's grandfather, a World War II Veteran
I wanted to let people know about the resources that are out there, because in my family we didn’t know the signs to look for and didn’t realize what was happening." - Cassie Cobb
“They decided to heighten awareness by concentrating on one specific issue,” he said. “They asked my opinion of the idea, and I told them I thought it was fantastic. Once they had completed their work, I made some suggestions and comments, and directed them toward a couple of other topics within the broader subject of suicide among Veterans that they could speak on.” Students substantiated their effort by researching and citing pertinent articles within the literature. “It was a lot of work all the way around,” Langston said. “They had to do considerable prep work beforehand, and then when they arrived at the convention, they were confronted with a very busy environment. They also had to attend hearings and man a table, where convention-goers could drop by and ask questions about authoring the resolution.”
SNA PROMOTES LEADERSHIP "Being a dues-paying member of the Student Nurses Association (SNA)—the UAB School of Nursing has nearly 200—requires dedication above and beyond the already demanding academic commitments," Langston said. Then to be elected to the association’s board of directors or the board’s executive committee requires an even greater commitment of time and energy. For those prepared to take advantage of such an opportunity, the rewards can be long-lasting and far-reaching. “Students at the executive level of the SNA participate in career development and resume-writing classes and counseling from professional mentors at the national level,” Langston said. “They have access to leadership development and training workshops as well as learning how to create budgets. And during all of this, they have opportunities to run for leadership positions at the state and national levels." She predicted these students will become charge nurses, nurse managers and clinical leaders, and assume proactive roles in the nursing profession.
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Research
life-
saving research
Dr. June Cho dreams of giving preemies a better start WRITTEN BY CARY ESTES // PHOTOGRAPHY BY CALEB CHANCEY
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t is well known that testosterone is the primary hormone that increases bone and muscle mass as males grow. But could the very thing that strengthens boys during adolescence also be responsible for weakening them during infancy?
That is one of the possibilities being examined by June Cho, PhD, an Assistant Professor in the UAB School of Nursing, who has been awarded a five-year, $1.72 million R01 grant from the National Institute of Child Health and Development for her study, “Testosterone and Cortisol Levels in Infant Health and Development.” “Boys are more likely to be born prematurely and at a lower birth weight than girls, and boys have a higher rate of infant mortality,” Cho said. “So if boys in general are sicker than girls at an early age, why is that? What could be the possible factor we’re dealing with?” Cho said it has been suggested that the hormone cortisol is a possible predictor of infant health and developmental outcomes. But she said preliminary research through her previous R21 project indicates that testosterone might be a more reliable biomarker for these two outcomes. Cho's previous R21 research examined very low birth weight (VLBW) preterm infants for a period of six months. Through this new R01 grant, Cho and her research team will be able to extend the period of observation to 24 months. During this time they will track the levels of testosterone and cortisol in the infants, and observe the mothers and infants as they interact. Cho said her team plans to follow a total of 190 VLBW infants and their mothers over the next five years.
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Cho explained that male infants experience a surge in testosterone during the second and third months of pregnancy, and then again during the early weeks after birth. It is speculated that a boy’s brain becomes masculinized during these periods. Cho said she wants to examine the relationship between the mother’s stress level and her baby’s testosterone level, and how this affects the infant’s cognitive, motor and language development. “I would like to confirm that testosterone, rather than cortisol, is a more reliable biomarker of complications affecting infant health outcome, maturation and development,” Cho said. “I want to confirm that the male infant has a higher sensitivity to testosterone than the female infant. The levels are the same at birth, but males usually have a surge just after birth. I would like to identify the root of this surge of hormone level in the health and development of low birth weight infants.” If it turns out that there is a correlation between increased testosterone levels and infant development, Cho said that discovery could lead to the development of early screening tools for a variety of behavioral disorders, such as autism. “Once the associations between these hormones and infant health and developmental outcomes are firmly established, the study outcomes will guide us in developing a future intervention for at-risk male infants,” Cho said. “We don’t know if there is a cause-and-effect between testosterone and infant outcome, but if there is, we can develop tailored interventions. “Today it’s all about prevention. The current diagnosis for such disorders is around age 2 or 3. But by then it’s a little bit late to correct, because the period before age 3 in brain
development is the most important period. If we miss that window, we’ve lost an opportunity. With this research, perhaps we can screen infants earlier. We have a lot of opportunities to help infants if the problem is diagnosed sooner. If we bring it down a year or even six months, that is much better. Earlier diagnosis allows earlier interventions.” Wally Carlo, MD, Director of Neonatology and Edwin M. Dixon Professor of Pediatrics at UAB, assisted Cho in the initial R21 study as well as the R01. Carlo agreed that earlier detection of potential behavioral disorders would be extremely beneficial. “Development can be nurtured,” Carlo said. “It’s like a growing tree. It’s very easy to alter it initially, but much harder once it’s grown. That’s what we’re aiming for, to
There is not a lot of research in this area, so this study is going to be very important. This is a great example of how the UAB School of Nursing is generating knowledge that will change the world.” -Dr. Wally Carlo
determine as early as possible what the influences of these hormones are on behavior. If we determine that hormonal levels are associated with behavioral issues in male infants, there could be interventions developed in a more timely way. “It’s important to determine whether differences in the hormone level in premature babies explains some of the outcomes of infants. They’re born prematurely, so there are a lot of changes that occur throughout gestation that these babies are
missing. We’re very interested in determining the association of hormonal imbalances – like testosterone imbalances – on the long-term outcome of babies. There is not a lot of research in this area, so this study is going to be very important. This is a great example of how the UAB School of Nursing is generating knowledge that will change the world.” Cho said the research is especially important to her because of the physical and emotional vulnerability of infants. “The reason I am so interested (in this work) is because babies are innocent when they are born. But because of some detrimental influences from the environment or biological factors, sometimes their development is compromised,” Cho said. “It’s my dream to help these babies get a better start to life.” FALL 2014 / UAB NURSING
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Innovation Leading the nation using interprofessional simulation in education WRITTEN BY GAIL ALLYN SHORT // PHOTOGRAPHY BY CHARLIE PRINCE
Real-World Preparation
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o strengthen teamwork and communication among disciplines, the UAB Schools of Nursing, Medicine and Health Professions are collaborating to offer immersive interprofessional simulation training, allowing students from different disciplines to work together in high-stress medical simulations before they enter the workforce.
UAB School of Nursing Professor and Chair Jacqueline Moss, PhD, RN, FAAN, said that in addition to poor communication, differences in training and priorities and the differing perspectives between nurses, physicians and other health care professionals can jeopardize patient safety. The problem, Moss said, is that health care professionals from different disciplines almost never work together until after they arrive on the job. “At that time, they know very little about what each of the other professions brings to the table, what their skills are, and what their body of knowledge is,” she said. “When you work as a team to take care of patients, particularly very ill patients, that’s not the time to be learning on the job what the nurses on the team are supposed to be doing.”
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“The field of simulation has been building over the past two decades and really gained momentum over the past five to 10 years,” said Hughes Evans, MD, PhD, Associate Dean for Medical Education in the UAB School of Medicine. “People increasingly recognize it’s a wonderful tool for building teamwork and that quality health care is reflected in how well the team works together to provide care for patients.” At UAB, the training is supported through the Office of Interprofessional Simulation for Innovative Clinical Practice. Established in 2011, the Office is a joint venture between the Health System, School of Nursing, School of Medicine, School of Health Professions and other professional schools to provide the resources needed to organize collaborative simulation experiences for their students.
Selwyn Vickers, MD, Dean of the School of Medicine said, “Interprofessional education is a critical component of medical and nursing student education, and professional development.” The simulations are held in labs made to look like real emergency and hospital rooms, and intensive care units. Often, patients are medium- and high-fidelity computerized mannequins, said Penni Watts, MSN, RN, Director of Clinical Simulation and Training in the School of Nursing. “The [mannequins] have breath, heart and bowel sounds, have pulses, and their chests can rise and fall, all of which are controlled by faculty via computer,” Watts said. From the nearby control room, faculty members can even become the voice of the mannequins to react to the treatments
or describe symptoms to the students. The students work together as they would in a real clinical setting, checking patients’ vital signs, administering medications and treatments, posing questions to patients and discussing the cases with each other. They also discuss and practice scenarios, including disclosing medical errors, giving bad news and end-of-life care. The simulations are often built upon faculty members’ clinical experiences and expertise. In addition to nursing and medical students, simulation participants have included nurse anesthesia, physician assistant, respiratory therapy and social work students. Often nursing students participate in interprofessional simulations as part of their clinical and skills classes throughout their entire curriculum. More than 150 clinical simulations are planned for each pre-licensure nursing student in the 2014-2015 academic year. “Learning how to work on a team where you learn to speak up and you’re empowered to be a patient advocate leads to better decision-making and ultimately better patient care,” Watts said. Simulations prepare nursing students and others for practice, Moss said, and help them understand the roles, capabilities and responsibilities of other medical professionals, all integral to effective team performance, and high-quality, safe care. “Simulation gives them the opportunity
The majority of the interprofessional simulations take place in UAB Hospital’s Center for Patient Safety and Advanced Medical Simulation. Construction is now underway in Volker Hall to create more space for interprofessional simulations.
Learning how to work on a team where you learn to speak up and you’re empowered to be a patient advocate leads to better decisionmaking and ultimately better patient care.” - Penni Watts to be leaders, to step up, to make decisions and mistakes while continuing to learn without dire consequences,” she added. After each simulation, students gather for debriefings, said Marjorie Lee White, MD, Associate Professor of Pediatrics, and Interim Co-Director of the Office of Interprofessional Simulation for Innovative Clinical Practice. “Putting them together in a simulated setting is the absolute best laboratory for figuring out why things go wrong when we’re actually taking care of patients,” said White, who is also Director of Medical Student Simulation in the School of Medicine.
Chad Epps, MD, also Interim Co-Director of the Office of Interprofessional Simulation for Innovative Clinical Practice and Associate Professor in the School of Health Professions, said while interest in interprofessional simulation is gaining popularity nationwide, UAB’s initiative stands out for the variety of mock simulations it offers, including a long-shift simulation of an ICU experience. “We’re also unique in just the sheer number of students who participate,” Epps said. “If you look at other institutions that are doing interprofessional simulations, they tend to have fewer nursing and medical school participants, so the logistics of getting that many people in a room, while having a limited number of simulation trained faculty, is something we do quite well.” Ultimately, Moss said, interprofessional simulation training at UAB is developing nurses who will be better able to help prevent medical errors, improving quality and patient safety. “They will be better prepared for the clinical area, better prepared to communicate with other team members in the clinical area, and better prepared to advocate and care for their patients,” she said.
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Research
Leading Transitional Care $1.5M NEPQR grant supports new heart failure clinic WRITTEN BY JENNIFER LOLLAR // PHOTOGRAPHY BY NIK LAYMAN
Dr. Maria Shirey and Dr. Connie White-Williams
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magine being discharged from the hospital knowing you suffer from heart failure, and you have no access to continuing outpatient care. What do you do when you’re in trouble— go to the emergency room, get readmitted, or worse, do nothing? It’s a recipe for a vicious cycle that could have disastrous outcomes. UAB patients will soon have support to prevent that from happening. Born of the UAB Nursing academic practice partnership between the School and UAB Hospital, a new nurse-managed, population-based transitional care clinic for heart failure patients recently discharged from UAB Hospital is opening in September 2014, supported by a $1.5 million Nurse Education Practice Quality Retention (NEPQR) grant from the Health Resources and Services Administration (HRSA). An interprofessional team of nursing, medicine, social work, health services administration and health information technology professionals, comprises this innovative, replicable collaborative practice model clinic and targets the underinsured and medically underserved. The three-day-per-week clinic and its around-the-clock transitional care support fill a much-needed gap. “Recent closure of the regional indigent-care hospital, Cooper Green Mercy Hospital, has created a critical access issue for this vulnerable population,” said the project’s director, Maria Shirey, PhD, RN, FAAN, Assistant Dean for Clinical and Global Partnerships. “The School already has experience leading the successful nurse-managed PATH clinic at M-POWER Ministries, geared to a population with diabetes. This new clinic expands our reach, serving as a ‘hub’ for transitional care coordination services for a high-risk population of heart failure patients across the hospital, clinic, home and community.” Over the past several years, UAB has been monitoring clinical outcomes in heart failure patients, said Connie White-Williams, PhD, RN, FAAN, Director of the Center for Nursing Excellence at UAB Hospital and Shirey’s partner in the project. Inconsistent length of hospital stays have been observed, along with higher-than-desired readmission rates. Traditional quality efforts, she said, have only modestly improved the rates and further
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development of new, more effective strategies is needed. “We believe this model with its aroundthe-clock transitional care coordination across the hospital, clinic and home will be effective in keeping patients at home and as healthy as possible,” Shirey added. “And what we learn from this initiative can ultimately change the existing model of care to benefit all heart failure patients.”
We believe this model with its around-theclock transitional care coordination across the hospital, clinic and home will be effective in keeping patients at home and as healthy as possible...” - Dr. Maria Shirey Transitional care coordination begins while patients are still in the hospital, Shirey said. A clinical nurse leader will serve as a case manager to coordinate care across the health care continuum and be on call for issues that may arise after clinic hours. Nurse practitioners will see patients during clinic hours and make daily inpatient rounds on eligible heart failure patients at UAB Hospital. Team members also will evaluate patients for palliative care eligibility, and contact them within 48 hours of hospital discharges to ascertain their well-being and confirm scheduled follow-up clinic visits. “A nurse practitioner then will make an initial home visit to assess the patient’s status and social support, as well as other issues that could impact his or her health, including not having air conditioning, or even something as simple as not having a scale on which to weigh,” she said. Shirey added the population-based transitional care team will use the hospital’s
new EMMI Solutions technology, an automated voice-response technology, to set up electronic patient phone call reminders to trigger self-reported weigh-ins and provide reminders about appointments and care recommendations. EMMI is already being used at UAB Hospital for other patient populations. A unique aspect of the clinic, Shirey said, is the incorporation of palliative care services. UAB School of Nursing Marie O’Koren Endowed Chair Marie Bakitas, DNSc, NP-C, FAAN, has an internationally recognized, NIH-funded program of research focused on delivering targeted palliative care interventions customized for heart failure patients and their caregivers. Bakitas will help the team to integrate palliative care principles into all aspects of care to help improve quality of life for both the patients and their families. As part of a world-class academic medical center, there also is an educational component to the clinic. Graduate nursing and health systems administration students from the School of Nursing and School of Health Professions will be involved during the project start-up phase—conducting needs assessments, performing information flow and workflow analyses, ensuring the operability of electronic medical records, and developing and implementing a plan for smooth clinic operations. Eventually, a variety of students will be incorporated as members of the health care team. This includes bachelor’s through doctoral nursing students, bachelor’s-level social work students, and medical residents and fellows in cardiology. They will participate in morning team huddles and afternoon post-conferences, and will provide input on team functioning at the end of each clinic day. Team members for the clinic also include UAB School of Nursing Assistant Professor Shea Polancich, PhD, an expert on quality and safety, and UAB cardiologist Vera Bittner, MD, the clinic’s collaborating physician.
ALUMNA NAMED CNO OF UAB HOSPITAL UAB Hospital Interim Chief Nursing Officer Terri Poe, who earned her BSN from the UAB School of Nursing in 1986 and her DNP from the School in 2013, has been named the hospital’s Chief Nursing Officer and Senior Associate Vice President. The appointment, effective August 1, was made by Anthony Patterson, Senior Vice President for Inpatient Services, also an alumnus of the School. “When I graduated from our BSN program my goal was to be part of nursing leadership for UAB Hospital,” Poe said. “I joined UAB five years ago as Director of Emergency Services and am fortunate to have developed great relationships with members of the clinical and academic nursing team. Completing our DNP program in 2013 has given me the tools needed to perform at my best as CNO. I am very excited about the great things that the UAB School of Nursing and UAB Hospital will do together to take UAB Nursing to the next level.” FALL 2014 / UAB NURSING
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Research WRITTEN BY CATIE ETKA PHOTOGRAPHY BY ROB CULPEPPER
Undergraduate students develop passion and understanding for the elderly
Research
Rosetta Norman
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osetta Norman never thought she would end up with a passion for research or taking care of adults. The second-semester BSN student plans to be a NICU nurse once she graduates, but joining a faculty member’s research team has opened her eyes to more career possibilities and might just change her mind about the age of her patients. Norman is one of 30 students, many of them undergraduates, working with Associate Professor Rita Jablonski-Jaudon, PhD, CRNP, FAAN, who is leading a National Institutes of Health (NIH) funded study on reducing care-resistant behaviors during oral hygiene in persons with dementia. The study is exploring various techniques to avoid care resistance in order to effectively implement mouth care. “This is an incredible opportunity for undergraduate students to gain research experience,” Jablonski-Jaudon said. “Active participation on a research team is an unusual and rare opportunity for BSN students and they are in a position to see cutting-edge research unfolding before their eyes. The UAB School of Nursing is unique to have active research opportunities for undergraduate nursing students.” “I have never been involved in a research study before and Dr. Jablonski-Jaudon’s study has given me a better understanding of how clinical research is performed,” said Ryne Duren, RN, a recent graduate of the School who now works on the UAB Hospital Renal Pancreas Transplant Unit. “I loved learning how to take concepts and directly apply them to care.”
“My experience has made me more aware of what happens in nursing homes. It has taught me that I would like to possibly become a researcher and help make strides in bettering health care for geriatric patients.” - Rosetta Norman
Many of the students, like Norman and Duren, had little to no experience with geriatric patients prior to the study. Jablonski-Jaudon said not only are they gaining unparalleled research experience, they are gaining insight into the rapidly growing geriatric population— something that will help the students excel as clinical and research leaders as they move into careers. The UAB School of Nursing has recently been named a National Hartford Center of Geriatric Nursing Excellence. This designation means that national experts in aging have recognized the School’s synergistic research capacity, clinical expertise, and commitment to educate nurses about the needs of geriatric patients across settings. “This research opportunity is one way of integrating geriatric research, practice and education in fulfillment of the NHCGNE mission,” noted Jablonski-Jaudon. Norman added, “My experience has made me more aware of what happens in nursing homes. It has taught me that I would like to possibly become a researcher and help make strides in bettering health care for geriatric patients.” Likewise, Duren said his outlook on the geriatric population also has changed. He has learned to approach dementia patients gently, to always be cognizant of their rights, and that while dementia patients may not remember your name, or what they did the previous day, “they recognize your face and you can still form a special connection with them.” The research project is expected to conclude in February 2015.
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The Assessment LEADERSHIP SHIP
COLLABORATION Even with resource limitations the clinic runs seamlessly, efficiently, and we are able to fulfill each individual's needs. The amount of relief and joy is evident on our patients' faces when they learn we can and will help them.” -Michele Talley, MSN, ACNP-BC, nurse
Enhancing the DNP program Doctor of Nursing Practice students in the UAB School of Nursing are encouraged to think outside the box and set a course to become nursing and health care leaders. The School’s newly redesigned DNP program enriches the knowledge BSN and master's-prepared nurses already have and provides them with the skills to become front runners in advanced practice nursing, said Linda Roussel, PhD, NEA-BC, CNL, the UAB program’s new director. She is leading the implementation of a new curriculum for the joint program, shared with the University of Alabama in Huntsville College of Nursing and University of Alabama Capstone College of Nursing. The revision ensures students take away a newfound skillset and tactics for organizational leadership, systems management and practice improvement. “The courses serve as a scaffold, and are rooted in evidence-based practice, improvement science and translation,” said Assistant Professor Shea Polancich, PhD, RN, a core faculty member in the program and member of the curriculum committee. "The new curriculum prepares our DNP students with the competencies to develop innovative models of care, conduct program evaluation leading to best practices, translate science to clinical practice, disseminate population-based interventions, or improve patient safety and quality. Our advanced practice nursing graduates will be equipped for tomorrow's health care," added Roussel.
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practitioner at the M-Power diabetes clinic
NEPQR making a difference for those living with diabetes Diabetes is an enormous problem in Alabama, but a UAB School of Nursing-managed post-discharge diabetes clinic is making the difference for hundreds of uninsured patients. UAB Hospital’s emergency department sees a large number of people each year who do not have control of their disease. Once discharged, they are told to follow up with their primary care provider, but many do not have one. The PATH Clinic in M-POWER Ministries fills that role. The clinic is supported through the Nurse Education Practice Quality Retention (NEPQR) program, and by the School, M-Power and UAB Health System. A significant number of uninsured have received care from the clinic’s group of providers, including nurse practitioner faculty, physicians, an optometrist, a dietitian and a nurse care manager, and students from those disciplines. Cynthia Selleck, PhD, RN, FNP, Associate Dean for Clinical and Global Partnerships, said preliminary data from the clinic indicate that access to comprehensive care is yielding positive results. “The data show success in improving the health of this population,” said Selleck. “And the level of interprofessional collaboration at the M-POWER clinic is outstanding, modeling teambased care.”
The Assessment RESEARCH
INNOVATION
Meneses named FNINR Ambassador
School of Nursing leading campus-wide transition to Canvas
UAB School of Nursing Professor and Associate Dean for Research Karen M. Meneses, PhD, RN, FAAN, has been selected as one of 12 inaugural Friends of the National Institute of Nursing Research (FNINR) Ambassadors. The Ambassadors are leaders in the nursing and health care research community, and possess stellar research, leadership and communication skills. They are charged with educating congressional leaders and others within their respective communities and advocating for improved funding by highlighting the impact nursing research has on the health and well-being of all Americans. Meneses received the 2013 Ada Sue Hinshaw Award from the FNINR, one of the highest honors that can be given to a researcher in the field of nursing, and has had continuous peer-reviewed funding for more than 25 years supporting her research in cancer survivorship issues among underserved populations. She also is on the CDC Advisory Committee on Breast Cancer in Young Women.
FROM THE ARCHIVES The growing social emphasis on “well care” rather than on “illness care” stimulated School of Nursing faculty to explore alternative student learning and patient care experiences in the primary care setting. Growing interest in reaching out to the elderly through community nursing resulted in faculty, including Dr. Mildred Hamner,organizing the Bankhead Towers Clinic in 1978.
The UAB School of Nursing is leading the way in the campus-wide transition to a new learning management system for distance-accessible courses. The University made the switch to Canvas based on the School’s successful pilot run in fall 2013. Instructional Design Manager Dan Murphy said a continuing education course was established using Canvas. The team was impressed with the system’s usability and shared its positive experiences with University colleagues. A number of peer-reviewed papers and invited presentations also resulted—Nancy Wingo, James Henson and Matthew Jennings presented at a national Canvas conference in June 2014. Jacqueline Moss, PhD, RN, FAAN, Professor and Chair, put together the Canvas implementation team, comprised of 12 faculty and staff members. She said the ease of transition is partly due to the structural cohesiveness of Canvas, but a large part is the hard work of the team. UAB is now trying to replicate the School’s teamwork and streamlined transition. The University has asked the School’s team to head the campus-wide transition in fall 2014.
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BIO James (Jim) Raper, PhD, CRNP, JD, FAANP, FAAN, is a tenured Professor in the UAB School of Medicine, the only nurse with a primary appointment, and holds a secondary appointment in the School of Nursing. As Director of the UAB 1917 Clinic, Raper leads a multidisciplinary team of dedicated HIV health care professionals serving more than 3,000 individuals. In early 2014, he was featured in the book Positive, which traces the life of internationally known HIV/AIDS expert and Director of the UAB Center for AIDS Research, UAB Professor Michael S. Saag, MD. It is the first time Raper publicly acknowledged his own HIV diagnosis.
FIVE QUESTIONS WITH
{ Jim Raper } INTERVIEW BY JENNIFER LOLLAR // PHOTOGRAPHY BY STEVE WOOD
Q: Why did you allow Dr. Saag to tell your story in the book Positive? A: Mike thought it was a valuable story to intertwine throughout the book. He came to me and said he thought my story is very powerful and would really resonate with people. And I thought about it and it just seemed to make sense to me at this point in my career and at this point in my life. I have nothing to be ashamed of and nothing to hide. I have a disease I acquired when I was quite young and I’ve lived with it. Fortunately I've done extremely well. And I think if other people can know my story they can say, “He can do it, I can do that too.” 26
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Q: Did you have any concerns at what the reaction might be? A: My biggest concern was for my patients. When you take care of people I think it’s very important to maintain the patient-provider relationship. I don’t think it’s a healthy thing for patients to be thinking about my disease or my problems. Anytime when people over the years have asked—and I don’t lie to people—I would say my health status is not why you’re here… your health status is why you’re here today and we need to stay focused on that. And I’ve had colleagues from all over the United States who have emailed me or called me after reading Dr. Saag’s book to say, “Jim I’m so proud of you for coming out like this and for being open. It’s meaningful. It has an impact.” I’ve only had support and affirmation from my colleagues who have contacted me.
Q: Was stepping away from seeing patients after your diagnosis a consideration because of the stigma of HIV? A: I’ve never thought about not taking care of patients. I was originally diagnosed in the mid-1990s but I remember when I was infected. I was in the Army, 1982… when I became deathly ill with high fever and a rash and I was hospitalized. We didn’t know that HIV even existed then. The Army physicians diagnosed me with a strep infection although I never had a positive strep test. In retrospect I’m sure it was an acute viral syndrome. Many years later, I went on HIV medications through an early clinical trial here at UAB. I’ve been on them a long time and I’ve done extremely well. Naturally, I would not have chosen this if I had my druthers but it’s what my life has brought to me and I’ve never thought about not being involved in the battle against HIV.
Q: How over the years has your diagnosis influenced your practice or research? A: Every successful person I know is driven by something. My something has been my LGBT community, growing up as a gay youth in rural North Carolina, in an Appalachian religious environment, and then entering college and going into the military. It was about that time when the HIV bomb fell and began its rippling devastation. I lost so many friends. I can’t even begin to count the number of friends and associates who
died—and my first partner. When I had the opportunity to get involved with HIV science and health care I wanted to seize the moment. Once I got into it and saw the wonderful opportunities that the new emerging medications offered to improve the lives of all of these people who were essentially given a death sentence, I became more and more excited and more and more engaged. The memories of the patients, friends and loved ones I have lost, and the hope for tomorrow for the patients that I take care of, have sustained me over the past 18 years.
Q: What has been your proudest moment at the 1917 Clinic? A: What we have individually and collectively accomplished during this past year for our patients during the transition of the St. George’s Clinic to the 1917 Clinic. With the closure of Cooper Green Mercy Hospital (the county hospital) and the absolute travesty of what happened when government turned its back on the people it was supposed to protect…UAB and Jim Raper said we’re not going to let those people go without health care. We did what we needed to do to bring in those 800 patients. We provided them with a medical home. Not once did any of the administrators from UAB give me any pushback in terms of doing the right thing and taking care of those patients. It was a huge potential for economic adversity, but we were able to bring those people on and integrate them into our clinic. I could not be more proud of UAB or the 1917 Clinic.
ADVANCED PRACTICE NURSING AT THE 1917 CLINIC Jim Raper is proud to be a nurse practitioner and to have been the first nurse to direct a medical clinic at UAB. This, he said, has afforded him the opportunity to incorporate advanced practice nursing into every aspect of the 1917 Clinic. There are two mental health-psychiatric advanced practice nurses from the School of Nursing who do their faculty practice at the 1917 Clinic, and a women’s health nurse practitioner and five family nurse practitioners fully integrated into the care delivery model in the clinic.
“A well-qualified workforce is difficult to maintain. Incorporating faculty members from the School of Nursing who are on the cutting edge of health care and research, and incorporating them into this practice arena, provides much-needed care to people in need, while it affords the nurse practitioners the opportunity to think about and explore their research interests,” he said. That is why he is working to add more faculty members to the clinic. Currently, Teena McGuinness, PhD, CRNP, FAAN, and Susanne Fogger, DNP, CRNP, PMHNP-BC, provide mental health care to patients who would otherwise not have access to it. “For those patients it has been a true blessing,” he said. “For our clin-
ic it has been incredibly important because we would not have been able to provide access to muchneeded psychiatric/ mental health care. Every one of these patients they provide care to is a person. An individual’s life is meaningful in so many ways.” Raper is in the process of developing additional relationships with at least two other faculty members who will help meet the demand of the increasing numbers of patients the clinic serves. “To me it’s been an invaluable experience maintaining a healthy relationship with the School of Nursing,” he added. “Having a school that is so close and integrated with us is significant for our community and the people we serve.” FALL 2014 / UAB NURSING
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Resources
Another Hit for WRITTEN BY ANITA SMITH // PHOTOGRAPHY BY NIK LAYMAN
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at the Virginia Samford Theatre and netted more than $70,000 to support the School. he 2014 fundraising event hosted by the UAB School of Nursing Board of Visitors drew strong student and faculty praise and gratitude.
“I left this event feeling so fortunate to be a student in the UAB School of Nursing and grateful to the Board of Visitors for their support of our School,” said Meghan Pattison, a 20-year-old second-semester BSN student from Peachtree City, Ga. “It was encouraging to me to see that members of the Board of Visitors believe in us as students, that they believe what we will be doing as nurses will make a real difference, and that they are investing in our future.” Accolades also came from faculty member Aimee Chism Holland, DNP. “I am fortunate to be among faculty who have the opportunity to teach UAB’s great nursing students,” she said. “I cannot express how powerful it was to attend this fundraiser and see how people in the community support what we do at the UAB School of Nursing.” These comments were in response to the 19th fundraiser that the Board of Visitors community-support group has hosted during its 22-year history. This year’s event, the third with the theme Applause for the Cause, was held May 13
“I cannot express how powerful it was to attend this fundraiser and see how people in the community support what we do at the UAB School of Nursing.” - Dr. Aimee Holland
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“I loved the joy and spirit of the evening,” said Doreen C. Harper, PhD, RN, FAAN, Dean and Fay B. Ireland Endowed Chair in Nursing. She said that everywhere she turned she could feel strong support for the School. BOV Chair Robert E. “Bobby” Luckie III commended fellow board members for their continued support, calling them “dedicated, conscientious and hard-working.” Jeannie Horton, the School’s Senior Director of Development, said these fundraisers “have opened people’s eyes even more” to the importance of nursing and to UAB’s mission in educating outstanding nurses. Applause 2014 began with a theatre courtyard reception. It was followed by a comedic performance about womanhood starring actresses Lee Ann “Sunny” Brown, Kristi Tingle Higginbotham, Jan D. Hunter and Kristin Staskowski. For the third consecutive year the Applause performance was directed by Virginia Samford Theatre President Cathy Rye Gilmore. As a prelude to the performance the audience saw a video featuring five individuals—faculty member Aimee Holland, DNP, and BOV members Bruce E. Burns, MD; Eileen S. Meyer, CRNP; Barrett Brock MacKay; Juanzetta S. Flowers, PhD; and Fay Belt Ireland. Each explained his or her reasons for believing in and supporting the UAB School of Nursing. Pictured right: 1. Jan Hunter, Kristi Tingle Higginbotham, Lee Ann “Sunny” Brown 2. William J. Cabaniss, Jr., Catherine Cabaniss 3. Punky Eastwood, Barrett MacKay, Pete Eastwood, Rick MacKay 4. Doreen Harper, Sue Ellen Lucas, Wayne Finley 5. Rita Wright, Carol Sandner 6. Lone Broussard, Angela Pruitt, Juanzetta Flowers 7. Lee Styslinger, Jr., Corbin Day, William J. Cabaniss, Jr. 8. Kristin Staskowski 9. Kate Sexton, Laurie Yearout, Catherine Ann Schilleci, Debbie Norris 10. Patrons enjoying the cocktail hour
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Resources
PACESETTERS FOR THE
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riven by a crucial need for more space to house the fast-growing UAB School of Nursing, a building expansion has been proposed by Doreen C. Harper, PhD, RN, FAAN, Dean and Fay B. Ireland Endowed Chair in Nursing.
It is proposed that this two-part expansion would consist of an addition connecting to the School’s existing building, plus extensive renovation of the existing building. Base funding for the proposed expansion—$15 million— would come from donations made to the School as part of The Campaign for UAB, the recently launched fundraising initiative for the overall University. The proposed expansion’s base funding would be matched with other resources to complete a funding package of approximately $30 million.
The proposed School of Nursing expansion would be one of the anchors of the University’s Research Crescent. 30
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“Our School is growing rapidly, and we desperately need space,” said Harper. “In recent years our School’s enrollment has tripled, which makes us proud. At the same time, we are stretched in making the most of the more than 40-year-old limited space we have. We assign some faculty to tiny offices that formerly were closets. When our graduate students report for learning experiences, called intensives, some must sit at makeshift desks because there is not enough room.”
The Dean said she is “very excited” about the proposed expansion. She envisions a light-filled Grand Atrium as the centerpiece for a new entrance to the School. “A Grand Atrium would create a feeling of openness, light, innovative learning and new knowledge,” she said. “This concept focuses on opening our minds to even greater possibilities than our wonderful UAB School of Nursing has already achieved.” The proposed addition would face 18th Street South, and the UAB campus mas-
Birmingham Couple’s Lead Building Gift William M. “Bill” Ferguson and his wife Janice “Jan” Wood Ferguson made the first gift contributed to the UAB School of Nursing’s proposed building expansion. They were motivated by their belief in the broad reach of nursing to touch people’s lives. “Nurses support you, hold your hand, help heal you—in every happy and sad event in your life,” said Bill. “They are there when your child is born, when you are sick, when your parent faces some health challenge, and when you are losing that parent and need hospice care. At every happiness, sadness and anxiety, nurses are there for you.” The Birmingham couple spoke of feeling nursing’s touch firsthand. “When I underwent open heart surgery, I saw how important nurses were in my care,” said Bill. Jan added, “When my mother had hospice care, the nurses were so kind and gentle with her, and so caring to all of us in the family.” Married 45 years, the Fergusons are accustomed to making decisions together. Both heartily agreed to make a significant gift to the UAB School of Nursing’s proposed building expansion project.
ter plan has it anchoring part of the gateway for the University’s planned Research Crescent. Harper said the proposed addition would connect to what would be a beautifully renovated version of the School’s existing building. She said the goal of the proposed expansion and renovation is to create a dynamic showcase for the School’s excellent teaching, research and service programs—programs that have earned the School a ranking among the top 5 percent of nursing schools in the nation.
Shirley Salloway Kahn, PhD, Vice President for Development, Alumni and External Relations at UAB, shared her perspective about the proposed UAB School of Nursing expansion plans. “With the continuing growth in our enrollment in the School of Nursing, the expansion of our current building is critical to our ability to educate and train outstanding nursing professionals to serve the critical need for nurses in our city, state and nation.”
“I’ve always liked the idea of leveraging, doing something to help multiply,” said Bill. “By contributing toward this building, we can foresee more space to educate more great nurses—a legacy for the future.” Jan said it gives her a warm feeling “to know this gift will do good for a long time to come.” They said their gift reflects their gratitude for good that has come their way. They expressed gratitude for one another, for their romance that began when they met in a cafeteria. “Jan was beautiful then; she’s beautiful now,” said Bill. “And we have been blessed with a wonderful son, daughter-in-law, and four grandchildren.” They are grateful for Bill’s 36-year telecommunications career, during which he worked for Bell Laboratories, Western Electric, Southern Bell, South Central Bell, and BellSouth. When he retired, he was president of the BellSouth Network Group, overseeing employees in nine Southeastern states in the technical operation of BellSouth’s landline communication system.
By contributing toward this building, we can foresee more space to educate more great nurses—a legacy for the future.” -Bill Ferguson
Although this is the largest gift the Fergusons have made to the UAB School of Nursing, it is not their first. They began supporting the School in 1994, when they attended the first fundraiser sponsored by the School’s Board of Visitors. FALL 2014 / UAB NURSING
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Resources
His Investment in Caring Nurses WRITTEN BY ANITA SMITH // PHOTOGRAPHY BY ROB CULPEPPER
F
or 34 years, Jack W. Trigg, Jr., MD, practiced internal medicine in the Birmingham area. He was a member of a group practice that long was called Southside Internists and then, following a merger with another group Southview Medical Group. During those years Trigg developed a deep appreciation for roles that nurses play in patient care. “Who really looks after you when you are sick and in the hospital? The nurses,” he said. In more recent years, since his 1998 retirement, Trigg has continued to keep abreast of changes in the health care delivery system. His respect for nurses has become even stronger. “With the major changes we are seeing in how health care is delivered, I am convinced it is the wave of the future that nurses are taking on more responsibility,” he said. “I believe that nurses are the ones who more and more will be addressing patients as whole beings, that nurses are the ones who will be providing that main caring element for patients and their families.”
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With admiration for nurses already firm in his mind, Trigg was impressed when he learned that his former golf partner Bradford Kidd (who passed away in 2011) and Kidd’s wife Margaret, had become supporters of the UAB School of Nursing. Margaret Kidd is a member of the School’s community-support group, the Board of Visitors. “Knowing that Bradford and Margaret Kidd were supporters of UAB’s nursing school got me to thinking,” said Trigg. “I decided that I too was interested in supporting the School.” Trigg contacted Jeanie Sherlock, another friend who also is a supporter of the UAB School of Nursing, and discussed the idea with her. Jeanie Sherlock is a retired hospital nursing administrator; she’s the wife of retired plastic surgeon Eugene Sherlock, who was a medical-school classmate of Trigg; she also is an emeritus member of the UAB School of Nursing Board of Visitors. “Jeanie felt that what I had in mind about supporting UAB’s nursing school was a great idea,” said Trigg. So Trigg made his arrangements. He met with his attorney and made provisions in his will for a planned gift, to bequeath to the UAB School of Nursing a percentage of his Individual Retirement Account. For longtime physician Trigg, it’s comforting to know that his planned gift will go to a nursing school that is highly ranked nationally, and also that this nursing school is based at UAB. He feels a strong connection to UAB. It was on the campus now known as UAB where Trigg earned his medical degree. It was there where he did a fellowship mentored by widely known Dr. Tinsley Harrison. It was there, after his internship at Duke University, where he took his internal medicine residency. And, on a personal note, it was on that same campus where Trigg met the woman who would become his wife. Her official name was Dorothy Wynne, but she
had been known as “Peachy” Wynne ever since she was an infant born in Georgia and someone said, “She is a real Georgia peach.” “It was in 1956 when I met Peachy, just before I started my fellowship with Dr. Harrison,” said Trigg. “I was working in the Old Hillman emergency room as an acting intern. Peachy was a ‘pink lady’—a volunteer at the hospital (a forerunner of what is now UAB Hospital). She came down to the emergency room. And there I was, all dressed up in my bloody white scrub suit. Peachy thought I was cute. I thought she was cute, too. Two years later we were married.”
“I am glad that these funds can help the UAB School of Nursing to attract the best and brightest students— the best and brightest AND the most caring." – Dr. Jack Trigg
For decades Jack and Peachy Trigg shared their active lives together. There were many happy times, including the births and the rearing of their sons, John and James. There also were the trying times, including the tragic loss of John to a swimming accident when he was 13. James is now an attorney in Atlanta. Now, sadly, the decades of busy activities shared by Jack and Peachy Trigg have been interrupted by Alzheimer’s disease, which over the past several years has taken a steady toll on Peachy. The gift that Jack Trigg has arranged to bequeath to the UAB School of Nursing will be used to establish a fund named for him and his wife—the Dr. and Mrs. Jack W. Trigg, Jr. Endowed Support Fund for Nursing Honors. Monies in this fund will enable the UAB School of Nursing to interact in very meaningful ways with students who have demonstrated strong academic promise—students known as Nurse Scholars. This interaction can begin early on in the students’ college journey, when they are taking pre-nursing courses. “I am glad that these funds can help the UAB School of Nursing to attract the best and brightest students—the best and brightest AND the most caring,” said Trigg.
Jack and Peachy Trigg
Jack Trigg said that he feels good about his decision. “I feel completely satisfied with my decision to support the UAB School of Nursing through a planned gift,” he said. “I know it’s the right decision. In fact, I have such a good feeling that I have told others about it. When they ask what led to my decision, I’m very glad to tell them about the increasingly important roles I feel that nurses have in delivering health care and how nurses provide so much of that caring piece.” FALL 2014 / UAB NURSING
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Alumni Making a Difference GLOBAL LEADERS IN INNOVATION
The number one thing I learned at UAB was about collaborative research, crucial to me in my research that involves so many disciplines.” Noting that results from the first study are very promising, she said, “I thought if ubiquinol worked for somebody in danger of bleeding to death, could it also work for somebody with traumatic brain injuries. I’m excited about this.”
Janet D. Pierce, PhD, APRN, CCRN, FAAN Janet D. Pierce, who holds MSN and PhD degrees from the UAB School of Nursing, is the Christine A. Hartley Centennial Professor at the University of Kansas School of Nursing. She is a basic scientist conducting bench research on applications of the substance ubiquinol. This is an electron-rich form of what is familiar to many as coenzyme Q10—a vitamin-like substance found throughout the body and also made in the laboratory, used to address various health issues. In an ongoing study, Pierce and her colleagues have been investigating whether ubiquinol can reduce secondary injury, such as organ damage, caused by excessive loss of blood associated with hemorrhagic shock. Her next ubiquinol study, recently funded, will look at whether ubiquinol can be effective in treating patients suffering from traumatic brain injuries. Both studies are funded by the U.S. Department of Defense.
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In addition to her research accomplishments, Pierce has earned several teaching awards—at both undergraduate and graduate levels in the UK School of Nursing, plus UK university-wide honors that include the Chancellor’s Award for Outstanding Classroom Teaching. Pierce credits her UAB School of Nursing studies with preparing her well. She praised School faculty, including Dr. Jean Kelley and Dr. Dianne Piazza as being “so important to me.” She said she was privileged to spend time working with UAB’s Dr. John W. Kirklin, world-renowned cardiovascular surgeon. “The number one thing I learned at UAB was about collaborative research, crucial to me in my research that involves so many disciplines.” In writing a recent grant application, nurse researcher Pierce worked with a team that included two cardiologists, a cardiac physiologist, a psychologist and a pharmacologist. “That is a real mix of disciplines and we have to be speaking the same language,” she said. “I learned how to do that at UAB.”
Marsha Howell Adams, PhD, RN, CNE, ANEF Marsha Howell Adams, who holds BSN, MSN and PhD degrees from the UAB School of Nursing, was inducted for a two-year term as President of the National League for Nursing (NLN) in September 2013. “The NLN membership includes nurse educators in both academic and practice settings,” said Adams. “We are sending a message that by preparing highly competent nursing graduates we have the ability to advance the nation’s health.” Adams recently was named Dean of the University of Alabama in Huntsville College of Nursing. Prior to that she spent 31 years on the faculty of the University of Alabama Capstone College of Nursing in Tuscaloosa, most recently as Professor and Senior Associate Dean of Academic Programs.
Kristi Henderson, DNP, APRN, FAEN Kristi Henderson, a 2010 graduate of the Doctor of Nursing Practice program in the UAB School of Nursing, is a member of the 2013 cohort of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This affords her three years of coaching, education and support in leadership development through this internationally known program. “The health care system environment is rapidly changing,” said Henderson. “I want to better equip myself with tools to make a difference. Through this RWJF program I am gaining experience and making contacts with disciplines around the country to do just that.” She is Chief Telehealth and Innovation Officer, University of Mississippi Medical Center, Jackson, and Professor in the University of Mississippi School of Nursing.
T. Joe Knight, Jefferson County Commissioner T. Joe Knight, a graduate of the Nurse Anesthesia Program now based in the UAB School of Nursing, currently runs unopposed for a second term on the five-member Jefferson County Commission that governs Jefferson County, Alabama. In addition to his 1980 bachelor’s degree in nurse anesthesia, Knight holds an associate degree in nursing and a law degree. For 12 years he practiced as a certified registered nurse anesthetist (CRNA) and now is General Counsel for the Alabama Association of Nurse Anesthetists. “Having worked as a nurse and a nurse anesthetist I’ve been on the inside of the health care delivery system,” said Knight. “That helps me to better understand health-related issues faced by the Jefferson County Commission.”
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The Review: Leadership Books that are shaping the careers of UAB School of Nursing alumni, faculty and graduate students
DUELLYN PANDIS, BSN '93 Co-owner and President of Passport Health of Tampa Bay. Specializes in travel medicine and is passionate about the preventive aspects of travel medicine and vaccinations
Stand Out-Find Your Edge Win at Work by Marcus Buckingham THE BOOK: Showcases nine areas defined as strength roles and helps identify your leadership style. DUELLYN’S TAKE: "I better understood how I deal with situations for better or worse. It helps you understand how to be a greater asset to your coworkers and how to be a successful leader."
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JEREMY JORDAN
KARMIE JOHNSON, MSN '11
Acute Care Pediatric NP student; Co-Founder and President of the Nursing Graduate Student Association (NGSA) at the School. Staff Nurse in the Pediatric Intensive Care Unit at Children’s of Alabama
Instructor and Paul Coverdell Peace Corps Fellows Coordinator, UAB School of Nursing; Psychiatric Nurse Practitioner at PATH Clinic
Served as Branch Chief, NCNR, NIH, consultant to Manitoba Association of Registered Nurses, and faculty member at Rutgers, Emory and Thomas Jefferson Universities
Who Moved My Cheese? by Spencer Johnson MD
Flourish by Martin E.P. Seligman
Gardner’s Leadership Papers by John W. Gardner PhD
THE BOOK: A parable about two mice and two men who are trapped in a maze in eternal pursuit of cheese, and their attitudes and reactions once their source of food is gone. JEREMY’S TAKE: "The skill of adaptability is relevant and important in today’s health care arena. It is continuously changing and health care leaders need to be able to interpret, analyze, and act quickly."
DEIDRE M. BLANK, PhD '82
THE BOOK: Seligman is one of the leaders of the Positive Psychology movement to enhance well-being and fulfillment.
THE BOOK: Gardner, a world renowned expert, assembled a series of bound papers on leadership.
KARMIE’S TAKE: "How people define happiness and exhibit resiliency plays into compliance and overall health, affecting leadership potential. The book uses interactive exercise to assist the reader in analyzing and exploring attitudes and goals about the authentic life."
DEIDRE’S TAKE: "I recognized how large organizations diminish an individual’s chance to take active leadership roles; the importance of motivating people; working within the system and working it; and leaders require renewal; therefore, it’s important to continue your own learning."
UAB School of Nursing alumni can be found all over the world and want to share with their friends and colleagues what they love to do in their cities
New York, New York Chiang Mai, Thailand
See the grounds of Bhubing Palace, the royal family’s winter residence.
WIPADA KUNAVIKTIKUL PhD '94, Dean, Chiang Mai University, Chiang Mai, Thailand
Experience the influence of Buddhism at the many temples, including Wat Prathat Doi Suthep, Wat Prasing, Wat Suan Dok and Wat Umong.
Spend a day in Central Park.
JAMES PACE PhD '86, Associate Dean of Undergraduate Programs, NYU College of Nursing
Spend a day at the museums around the Park. These include the American Museum of Natural History, Guggenheim Museum, Metropolitan Museum of Art and Whitney Museum.
Every Sunday evening the major streets in the old city close for Chiang Mai’s largest craft market, The Sunday Walking Street — the best place to find local artisans’ work.
Eat khao soi, the signature dish of Northern Thailand, at the King of Thailand’s favorite restaurant, Khao Soi Lam Duan Faharm.
Visit Elephant Nature Park.
Eat anywhere and everywhere around the City. One of my favorites is Daniela’s Trattoria on 8th Ave between 45th and 46th Streets. It is great.
above the streets on Manhattan’s West Side. It runs from Gansevoort Street in the Meatpacking District to West 34th Street, between 10th and 11th Avenues.
Walk the High Line, a public park built on a historic freight rail line elevated
Enjoy a Broadway play in the evening... right now, the hot one is Aladdin.
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In Their Own Words { Real-life experiences as told by the clinicians, researchers, faculty and students who lived them } WRITTEN BY CHERI PLASTERS, BSN '84 — UAB HOSPITAL // PHOTOGRAPHY BY ROB CULPEPPER
ur patient Jim* had been critically ill for three months. He was in multi-organ system failure, which meant a variety of treatments were started—including ventilator life support—with the assumption they would help him, but nothing was leading to recovery. Like many other family members that still hold out hope, his sister Sally* was faced with medical decisions and plan-of-care involvement that made her uncomfortable and sad. She wanted her brother to receive the most aggressive medical treatment even though his entire care team was confident of his overall prognosis. What we didn’t know at the beginning was that Jim was a Vietnam Veteran. We learned of his service from Sally and about how he had a difficult time adjusting to civilian life, affecting his health. She explained that his past service was important to him, represented his willingness to fight for a cure, and influenced how she made decisions for him when he could not. On one of Sally’s visits she had an unusual request—an American flag to drape over Jim as a blanket. She spoke of his military service and asked us to
create a special ceremony to honor his service and sacrifices, while he was still living. She said she felt if he were recognized for his service she could start closure. Finding a flag turned out to be difficult—and urgent as Jim took a turn for the worse. I was determined to fulfill Sally’s wish, contacting anyone I could think of for help. Nearly a dozen nurses and other hospital staff were involved in the search. It became a quest for everyone. Finally, a Soldier from the UAB ROTC responded. He was so moved by this family’s request and the inability to find a fellow Veteran a flag that he offered to give his personal flag that had been with him in combat on multiple deployments to Iraq and Afghanistan. What made this extra meaningful for the family was that the Soldier came to the SICU in full uniform and made the presentation to the patient and family at the bedside, sharing with them the blessing of freedom that this flag represented. Soon after the flag was draped over Jim, Sally made the decision to change his plan of care and to allow him to die with dignity. After Jim died, his family donated funds for a flag ministry at our hospital to purchase flags for patients who request one during their hospitalization.
THE AMERICAN FLAG One family's symbol of hope and freedom from illness
This event reinforced for all of us the need for competencies in Veteran health and to obtain military health histories—to simply “ask the question.” Once we identify who are Veterans we can better seek to provide them with information and the recognition for their service that they deserve and explore concerns and exposures that are common to military Veterans as we plan their care. * Names changed for privacy For more on “ask the question” go to Joining Forces, joiningforces.gov, or the American Academy of Nursing’s Have You Ever Served in the Military? Campaign, haveyoueverserved.com.
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