Vision and Values: A Compass in Times of Change
“Our mission has always been to make a significant impact on improving the health of all people, to be the preeminent intellectual and transformative force in improving health through nursing,” says Antonia Villarruel, PhD, RN, FAAN, Professor and Margaret Bond Simon Dean of Nursing. “Our values guide our actions to accomplish this mission.”
The arrival of a new Dean in 2014 was an opportunity for the School to establish a new strategic plan and the process started with a reaffirmation of the organizational vision, mission, and values.
“Our most recent planning process was an opportunity to take a close look at what we were saying about ourselves and our actions and make sure that it made sense for now and the future,” adds Dr. Villarruel.
As it turns out, Penn Nursing’s values and mission are not just relevant, but timely.
“We had hours of robust discussions about what is happening in the world today – from the global economic crisis and climate change to accessibility of health care,” she explains. “It became apparent that social justice, inclusion, and impact are integral to our efforts in research, policy, practice, and education. They help us resolutely confront the realities of today’s world, lead change, and improve the lives of people everywhere.”
A Unique Perspective
Many contemporary issues, like human trafficking, climate change, and a growing population of elders, are complex and not only impact economies and societal stability, but also the health and well-being of communities. As the profession that, according to the World Health Organization (WHO), provides 90 percent of the world’s health care services and views the patient in the broadest context, nurses are key to addressing these concerns, particularly as they impact the most vulnerable populations.
“Any issue that touches human health is a nursing issue,” says Dr. Villarruel. “We have a role in prevention and treatment and in forwarding knowledge and leading change.”
As an example, Penn Nursing was among the first schools to sign the White House Health Educators Climate Commitment in 2015, pledging to prepare nurses to advance the knowledge and to effectively address the health impacts of climate change.
“On the surface, climate change and nursing may not seem congruent. But nurses work with people every day who have been affected by climate change – from the spread of vector-borne disease and respiratory illnesses exacerbated by poor air quality, to an increase in chronic conditions,” says Dr. Villarruel. “We also have the data that shows the effects of climate change on health. Our place is to share this knowledge and advocate for change.”
Among many other issues, nursing also brings an important perspective to ensuring that our aging population has the opportunity to thrive and that elders are not marginalized. The global population of people aged 80 and older is expected to almost triple by 2050 and the growth and proportion of older American adults is unprecedented. Nurses are prepared to understand aging, how it affects the psychosocial, physical, and emotional needs of elders, and to develop solutions that meet those unique needs.
“Even if you work with pediatric patients, you still need to understand how to communicate with your patients’ grandparents,” explains Pamela Z. Cacchione, PhD, CRNP, GNP, BC, FGSA, FAAN, Ralston House Endowed Term Chair in Gerontological Nursing and Associate Professor of Geropsychiatric Nursing. “Understanding the complexities of aging and having a positive attitude toward aging is imperative for all nurses.”
Dr. Cacchione has dedicated her career to understanding, serving, and advocating for frail elders. As a clinician educator at Mercy Living Independently for Elders – West Philadelphia (LIFE), she is part of an extensive interdisciplinary team that provides comprehensive medical, health, recreational, and social services to underserved and disadvantaged elderly, many of whom have at least four chronic conditions. “LIFE utilizes a nursing model of care designed to provide interdisciplinary, inclusive care for these frail seniors,” she says. “We have achieved great success in combating and reversing health disparities in this population, and have given countless nursing students the opportunity to engage with elders and learn just how resilient they can be.”
Many LIFE members come from populations that have been historically marginalized and underserved. Dr. Cacchione explains, “Working with these elders has provided a deep look into a population that has not been well understood. Despite the racism, health disparities, and trauma that LIFE members have experienced, they have thrived with interdisciplinary care. And they are incredibly generous in sharing their experiences to help us understand how those experiences have impacted their lives. They are helping us develop the interventions and care models that address social justice issues and health for a very large population.”
The Role of Research in Advancing Justice, Inclusion, and Impact for Vulnerable Populations
Almost always, historically marginalized and disadvantaged populations face a higher burden of illness, injury, disability, and mortality, and their access to and use of care is limited. These populations also have a long history of being excluded from research and therefore, potentially, from the benefits of that research. Nursing research has long focused on improving the outcomes for the most vulnerable.
“Nurse researchers play an important role in changing disparities and improving the culture of health,” says Dr. Villarruel. “By focusing on inclusion, impact, and social justice, our research challenges dominant truths and disrupts structural inequities in health care to enhance health and quality of life.”
Consider the health status of black men in the United States. They have the lowest life expectancy and highest mortality rate among men and women in all other racial or ethnic groups in the country.
“Urban black men from low-resource communities are at high risk for health disparities – yet this is not a population that society typically views as vulnerable,” explains Therese S. Richmond, PhD, FAAN, CRNP, Andrea B. Laporte Professor of Nursing, and Associate Dean for Research & Innovation.
Dr. Richmond has focused her research on addressing social injustice in health. She is passionate about using nursing science to prevent injury and violence and improve outcomes, particularly for vulnerable populations. “When we see preventable disparities in health states among different people – because of who they are, where they live, and resources that are available to them – nurse researchers can use science to tackle these disparities,” she says.
Similarly, Margo Brooks Carthon, PhD, RN, FAAN, Assistant Professor, Family and Community Health and Lisa M. Lewis, PhD, RN, FAAN, Assistant Dean for Diversity and Inclusivity are conducting research that integrates the tenets of social justice into health care. “Our ability to fulfill our commitment to nursing requires us to advocate for the rights of individuals to have access to health and experience good health outcomes, irrespective of personal characteristics,” says Dr. Brooks Carthon. “By focusing on the quality of care delivered to minority patients, we heighten our ability to transform and deliver care that is tailored to meet the needs and expectations of diverse patients and communities.”
Applying These Values to the Curriculum
Students are often drawn to nursing by a desire to make a difference. At Penn Nursing, they are not only exposed to a curriculum that will develop their critical thinking and technical skills, but one that will also bring their attention to issues such as social determinants of health, health equity, and the health impact of marginalization.
Lisa M. Lewis, PhD, RN, FAAN, Assistant Dean for Diversity and Inclusivity, and Cynthia A. Connolly, PhD, RN, FAAN, Associate Professor of Nursing, co-teach NURS 103, Psychological and Social Diversity in Health and Wellness. While the course focuses on health care access, health history, health promotion, and issues of equity and diversity, its real goal is to help students begin to think differently about health care and their role as care givers and advocates.
In NURS 103, students get a foundational introduction to the social determinants of health. They participate in case studies and small group discussions that enhance understanding about the many health disparities seen among different populations.
“Quite simply, we emphasize social justice and inclusion because that’s what nursing is about,” explains Dr. Lewis. “We give students the tools they need to think critically about their patients and to understand the context in which they live.”
That understanding helps students in their assessment of an individual’s health history by placing that patient’s health within a construct of the physical and social environment. Students can then more effectively communicate with the individual in order to improve health.
“We teach NURS 103 students that in their role as nurses, they must advocate for those patients who may not be well-equipped to do so for themselves,” says Dr. Lewis.
Later in the curriculum is NURS 380, Nursing in the Community, a course that helps seniors consider how nursing influences the health and healing capacities of populations and of groups, families, and individuals living within particular communities, locally and globally. Students work with vulnerable populations including the homeless, people with substance addictions, prisoners, mothers and babies, school children, and elders.
“In this course, students philosophically move from the acute/chronic care models to thinking about vulnerable populations and the social determinants of health that may limit those populations’ access to comprehensive health care,” explains Monica J. Harmon, MSN, MPH, BSN, Senior Lecturer.
Through clinical and simulated experiences, students learn to consider the impact of the social determinants of health on transitioning people through the health care system, including prevention services. And they also learn about the strengths and resilience of communities.
“This knowledge helps our students become professionals in delivering customized care to patients in a wide variety of settings, including hospital beds, prison cells, or community clinics,” she adds.
Penn Nursing students are committed to social justice and have high expectations that the nursing curriculum will help them explore inequities across race, gender, class, and community. That was illustrated during a 2016 town hall meeting when students asked that social justice be better threaded throughout the curriculum. “This has given Penn Nursing faculty much to consider with regard to how and what we teach,” says Dr. Lewis.
Collaborating to Overcome Health Disparities
Knowing that much of what significantly impacts health – like physical environment, socio-economic status and demographics – happens outside of health care settings, nurses have a long history of working in communities and partnering with a variety of stakeholders to improve outcomes. Today, Penn Nursing continues to broker conversations and collaborate around social determinants of health.
“We have long been associated with asking the questions that raise awareness of health care issues. And we are also very good at bringing people and groups together to begin the dialogue that develops solutions to impact change and overcome health disparities,” says Dr. Villarruel.
Leading by example, Dr. Villarruel chairs the National Academies of Sciences, Engineering, and Medicine Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities. The roundtable brings together people from diverse perspectives and sectors to address racial and ethnic disparities in health care, to find new strategies to overcome disparities, and to develop new leadership in targeted areas. In November, Dr. Villarruel and Dr. Laura Magana Valladares, Executive Senior Advisor, IANPHI Mexico Secretariat, National Institute of Public Health, shared the National Academy of Medicine’s report “A Framework for Educating Health Professionals to Address Social Determinants of Health” with the Penn community.
“Addressing social determinants of health requires transformational learning,” explains Dr. Villarruel. “It must be experiential and collaborative, and it must be ongoing.”
She also co-chairs the Strategic Advisory Committee for the Future of Nursing: Campaign for Action, an initiative of the AARP Foundation, AARP, and the Robert Wood Johnson Foundation. The campaign has been instrumental in improving America’s health through nursing. Action coalitions nationwide work with policymakers, health care professionals, educators, and business leaders to respond to the nation’s need for safe, high-quality, and effective health care.
“Chief among our initiatives is to push for change that allows nurses to practice to the full extent of their education and training,” says Dr. Villarruel. The committee’s collaborative effort has achieved important results: Eight states have increased consumers’ access to care by removing barriers that prevented nurse practitioners from providing care to the full extent of their education and training. Overall, in 21 states and the District of Columbia, nurse practitioners are allowed to provide full care.
“Nurses are key to meeting the health care demands of a growing underserved population,” says Dr. Villarruel. “Practicing to the fullest extent of our education and training allows us to play a key role in improving health outcomes of diverse populations.”
Constancy and Values
Social justice, inclusion, and impact are the foundation of Penn Nursing’s vision and mission. Those values are clearly woven into research, education, and practice and serve as a compass as the School puts its mission into action.
“Because our School is values-driven, we are able to interact effectively and make good decisions,” says Dr. Villarruel. “Our values help us take a holistic view of practice and science in order to positively impact all populations.”